Τίτλος:
Exhaled nitric oxide and carbon monoxide in mechanically ventilated
brain-injured patients
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
The inflammatory influence and biological markers of prolonged
mechanical-ventilation in uninjured human lungs remains controversial.
We investigated exhaled nitric oxide (NO) and carbon monoxide (CO) in
mechanically-ventilated, brain-injured patients in the absence of lung
injury or sepsis at two different levels of positive end-expiratory
pressure (PEEP).
Exhaled NO and CO were assessed in 27 patients, without lung injury or
sepsis, who were ventilated with 8ml kg(-1) tidal volumes under zero
end-expiratory pressure (ZEEP group, n = 12) or 8 cm H2O PEEP (PEEP
group, n = 15). Exhaled NO and CO was analysed on days 1, 3 and 5 of
mechanical ventilation and correlated with previously reported markers
of inflammation and gas exchange.
Exhaled NO was higher on day 3 and 5 in both patient groups compared to
day 1: (PEEP group: 5.8 (4.4-9.7) versus 11.7 (6.9-13.9) versus 10.7
(5.6-16.6) ppb (p < 0.05); ZEEP group: 5.3 (3.8-8.8) versus 9.8
(5.3-12.4) versus 9.6 (6.2-13.5) ppb NO peak levels for days 1, 3 and 5,
respectively, p < 0.05). Exhaled CO remained stable on day 3 but
significantly decreased by day 5 in the ZEEP group only (6.3 (4.3-9.0)
versus 8.1 (5.8-12.1) ppm CO peak levels for day 5 versus 1, p < 0.05).
The change scores for peak exhaled CO over day 1 and 5 showed
significant correlations with arterial blood pH and plasma TNF levels
(r(s) = 0.49, p = 0.02 and r(s) = -0.51 p = 0.02, respectively). Exhaled
NO correlated with blood pH in the ZEEP group and with plasma levels of
IL-6 in the PEEP group.
We observed differential changes in exhaled NO and CO in
mechanically-ventilated patients even in the absence of manifest lung
injury or sepsis. These may suggest subtle pulmonary inflammation and
support application of real time breath analysis for molecular
monitoring in critically ill patients.
Συγγραφείς:
Korovesi, I.
Kotanidou, A.
Papadomichelakis, E.
Livaditi, O.
and Sotiropoulou, C.
Koutsoukou, A.
Marczin, N.
Orfanos, S.
E.
Περιοδικό:
Journal of Breath Research
Εκδότης:
IOP Publishing Ltd
Λέξεις-κλειδιά:
lung injury; exhaled nitric oxide; exhaled carbon monoxide
DOI:
10.1088/1752-7155/10/1/017107
