Document Detail

Exhaled Breath Condensate in Mechanically Ventilated Brain-injured Patients with No Lung Injury or Sepsis.
MedLine Citation:
PMID:  21521967     Owner:  NLM     Status:  Publisher    
BACKGROUND:: The inflammatory influence of prolonged mechanical ventilation in uninjured lungs remains a matter of controversy and largely unexplored in humans. The authors investigated pulmonary inflammation by using exhaled breath condensate (EBC) in mechanically ventilated, brain-injured patients in the absence of acute lung injury or sepsis and explored the potential influence of positive end-expiratory pressure (PEEP). METHODS:: Inflammatory EBC markers were assessed in 27 mechanically ventilated, brain-injured patients with neither acute lung injury nor sepsis and in 12 healthy and 8 brain-injured control subjects. Patients were ventilated with 8 ml/kg during zero end-expiratory pressure (ZEEP group, n = 12) or 8 cm H2O PEEP (PEEP group, n = 15). EBC was collected on days 1, 3, and 5 of mechanical ventilation to measure pH; interleukins (IL)-10, 1β, 6, 8, and 12p70; and tumor necrosis factor-α. RESULTS:: EBC pH was lower, whereas IL-1β and tumor necrosis factor-α were greater in both patient groups compared with either control group; IL-6 was higher, whereas IL-10 and IL-12p70 were sporadically higher than in healthy control subjects; no differences were noted between the two patient groups, except for IL-10, which decreased by day 5 during PEEP. Leukocytes, soluble IL-6, and soluble triggering receptor expressed on myeloid cells-1 in blood were constantly higher during zero end-expiratory pressure; EBC cytokines appeared mostly related to soluble IL-8 and inversely related to soluble triggering receptor expressed on myeloid cells-1. CONCLUSIONS:: In brain-injured, mechanically ventilated patients with neither acute lung injury nor sepsis, EBC markers appear to indicate the presence of subtle pulmonary inflammation that is mostly unaffected by PEEP. There is evidence for a systemic inflammatory response, especially in patients during zero end-expiratory pressure.
Ioanna Korovesi; Evangelos Papadomichelakis; Stylianos E Orfanos; Evangellos J Giamarellos-Bourboulis; Olga Livaditi; Aimilia Pelekanou; Christina Sotiropoulou; Antonia Koutsoukou; Ioanna Dimopoulou; Foteini Ekonomidou; Ekaterini Psevdi; Apostolos Armaganidis; Charis Roussos; Nandor Marczin; Anastasia Kotanidou
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Publication Detail:
Journal Detail:
Title:  Anesthesiology     Volume:  114     ISSN:  1528-1175     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-4-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1118-1129     Citation Subset:  -    
* Resident, ∥ Research Associate, ** Statistician, †† Assistant Professor, ‡‡ Fellow, ## Professor, ††† Associate Professor, First Critical Care Department, Evangelismos Hospital and M. Simou Laboratory; † Attending, ‡ Associate Professor, ∥∥ Professor, Second Critical Care Department, Attikon Hospital and M. Simou Laboratory; § Assistant Professor, # Research Fellow, Fourth Department of Medicine, Attikon Hospital University of Athens Medical School; §§ Attending, Anesthesiology Department, Evangelismos Hospital, Athens, Greece; *** Senior Lecturer, Section of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom.
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