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Interface."],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>We investigate respiratory flow phenomena in a reconstructed upper airway model of an intubated neonate undergoing invasive mechanical ventilation, spanning conventional to high-frequency ventilation (HFV) modes. Using high-speed tomographic particle image velocimetry, we resolve transient, three-dimensional flow fields and observe a persistent jet flow exiting the endotracheal tube whose strength is directly modulated according to the ventilation protocol. We identify this synthetic jet as the dominating signature of convective flow under intubated ventilation. Concurrently, our<jats:italic>in silico<\/jats:italic>wall shear stress analysis reveals a hitherto overlooked source of ventilator-induced lung injury as a result of jet impingement on the tracheal carina, suggesting damage to the bronchial epithelium; this type of injury is known as biotrauma. We find HFV advantageous in mitigating the intensity of such impingement, which may contribute to its role as a lung protective method. Our findings may encourage the adoption of less invasive ventilation procedures currently used in neonatal intensive care units.<\/jats:p>","DOI":"10.1098\/rsif.2019.0516","type":"journal-article","created":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T08:07:16Z","timestamp":1578470836000},"page":"20190516","update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Ventilation-induced jet suggests biotrauma in reconstructed airways of the intubated neonate"],"prefix":"10.1098","volume":"17","author":[{"given":"Eliram","family":"Nof","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Technion\u2013Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Metar","family":"Heller-Algazi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Technion\u2013Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Coletti","sequence":"additional","affiliation":[{"name":"Department of Aerospace Engineering and Mechanics, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Waisman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Technion\u2013Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Department of Neonatology, Carmel Medical Center, Haifa 3436212, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8217-3842","authenticated-orcid":true,"given":"Josu\u00e9","family":"Sznitman","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Technion\u2013Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[2020,1,8]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61698-6"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60820-4"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61856-X"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1159\/000326628"},{"key":"e_1_3_6_6_2","volume-title":"Neonatology","author":"Gomella TL","year":"2013","edition":"7"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1208707"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1980.48.4.710"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.6771872"},{"key":"e_1_3_6_10_2","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1542\/peds.71.4.483","article-title":"High-frequency ventilation in premature infants with lung disease: adequate gas exchange at low tracheal pressure","volume":"71","author":"Frantz ID","year":"1983","journal-title":"Pediatrics"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(84)80604-6"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2006.12.004"},{"key":"e_1_3_6_13_2","unstructured":"Cools F Offringa M Askie LM. 2015 Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. 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