Urgent options: Lung physiologist explores how to help during a ventilator shortage

Gary Nieman conducts research on mechanical methods to help people breathe and to lessen any related injuries. He is shown in his laboratory at Upstate University Hospital.

BY AMBER SMITH

How to help large numbers of people with severe pneumonia during a pandemic had not crossed Gary Nieman’s mind.

Now it’s all he thinks about.

Nieman is a lung physiologist who has spent his career studying the origin, development and treatment of acute respiratory distress syndrome and ventilator-induced lung injury.

He and his research partners have some projects that may help people with COVID-19: Time-controlled adaptive ventilation (TCAV) method is a way to protect the lungs from damage that a ventilator — a breathing machine — may cause.

Nieman and his team describe this technique in the March issue of the journal Annals of Intensive Care, saying it “changes the current approach to mechanical ventilation, from arbitrary to personalized and adaptive. The outcome of this approach is an open and stable lung with reduced regional strain and greater lung protection.”

Nader Habashi, MD, the medical director of the critical care unit at the University of Maryland’s R. Adams Cowley Shock Trauma Center, developed the TCAV technique, and Nieman conducted extensive experiments in his laboratory at Upstate University Hospital to identify how well it works.

This technique is likely to help patients come off ventilator support more quickly, Nieman says, thus freeing up the machine for other patients and avoiding ventilator shortages.

A chemically modified tetracycline medication that Nieman’s lab studied from 1999 to 2011 as a possible treatment for acute lung injury still holds promise. He says the research halted after some corporate changes.

“It’s a unique drug with a lot of potential,” he says, describing the multiple anti-inflammatory properties that he believes would work well on COVID-19, which can be fatal when the body’s immune system overreacts in what is known as a cytokine storm.

Because previous work has shown this medication is safe for humans, Nieman is hopeful that it will be studied in patients who have COVID-19 in the near future.

Desperate measures, to be used only as a last resort, include dual ventilation or hand-held ventilators, Nieman says. “We must have options available for the physicians if the number of patients with respiratory failure exceeds the number of ventilators.”

Connecting two patients to a single ventilator is a complex process. Habashi wrote protocols for how this can be done, based on experiments Nieman conducted at Upstate.

Hand-held resuscitative equipment invented in the 1950s requires someone to squeeze each breath of air into the patient. Collaborating with researchers at Syracuse University, Nieman is testing a device that would take the place of a hand. It would connect to an oxygen source in a hospital room and function as a rescue ventilator if none were available.

After tests demonstrate that it works, Nieman says the plan is for the device to be rapidly produced on 3-D printers at SU if needed.

This article is from the spring 2020 Upstate Health magazine, a special edition dealing with the coronavirus.