Evaluation of systemic inflammation in patients being weaned from mechanical ventilation

Forgiarini, Soraia Genebra Ibrahim; Rosa, Darlan Pase da; Forgiarini, Luiz Felipe; Teixeira, Cassiano; Andrade, Cristiano Feijó; Forgiarini, Luiz Alberto; Félix, Elaine Aparecida; Friedman, Gilberto

doi:10.6061/clinics/2018/e256

Cited by 10 publications

(12 citation statements)

References 27 publications

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“…Several markers of inflammation, such as interleukin-6 (IL-6), IL-18 and C-reactive protein (CRP), have been correlated with poor prognosis in septic patients [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Specifically, IL-18, a pleiotropic pro-inflammatory cytokine with abnormal expression in sepsis and a marker of inflammasome activity, has a documented value as a prognostic indicator for the outcome of critically ill septic patients [ 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation

et al. 2021

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Introduction: Septic patients undergoing mechanical ventilation (MV) often experience difficulty in weaning. Th aim of this study was to determine whether inflammatory biomarkers of sepsis could be indicative of the failure or success of spontaneous breathing trial (SBT) in these patients. Methods: Sixty-five patients on MV (42 septic and 23 intubated for other reasons) fulfilling the criteria for SBT were included in the study. Blood samples were collected right before, at the end of (30 min) and 24 h after the SBT. Serum inflammatory mediators associated with sepsis (IL-18, IL-18BP, TNF) were determined and correlated with the outcome of SBT. Results: A successful SBT was achieved in 45 patients (69.2%). Septic patients had a higher percentage of SBT failure as compared to non-septic patients (85% vs. 15%, p = 0.026), with an odds ratio for failing 4.5 times (OR = 4.5 95%CI: 1.16–17.68, p 0.022). IL-18 levels and the relative mRNA expression in serum were significantly higher in septic as compared to non-septic patients (p < 0.05). Sepsis was independently associated with higher serum IL-18 and TNF levels in two time-point GEE models (53–723, p = 0.023 and 0.3–64, p = 0.048, respectively). IL-18BP displayed independent negative association with rapid shallow breathing index (RSBI) (95% CI: −17.6 to −4, p = 0.002). Conclusion: Sustained increased levels of IL-18 and IL-18BP, acknowledged markers of sepsis, were found to be indicative of SBT failure in patients recovering from sepsis. Our results show that, although subclinical, remaining septic inflammation that sustaines for a long time complicates the weaning procedure. Biomarkers for the estimation of the septic burden and the right time for weaning are needed.

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Section: Introductionmentioning

confidence: 99%

Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation

et al. 2021

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“…32 Previous studies have investigated the role of systemic in ammatory biomarkers to predict the extubation status in severe pneumonia patients. 35 However, to our knowledge, no previous studies had evaluated the local in ammatory biomarkers to guide the clinician in determining the extubation status of severe pneumonia patients, particularly in the right and left severely affected lung. Previous studies showed that sTREM-1, 5 alveolar macrophage, 15 IL-6, 16 IL-17, 17 CD4 and Tregs, 18 SP-A, 19 and Caspase-3 20 played a crucial role in local immunopathology (innate and adaptive immunity).…”

Section: Discussionmentioning

confidence: 99%

Low Alveolar Macrophage Function, Low IL-6, and High CD4 Cell Count Interaction in BALF of Severe Pneumonia Patients with Extubation Success

Singh

Rumende

Sharma

et al. 2022

Preprint

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BackgroundUnderstanding the bronchoalveolar-lavage fluid immunopathology biomarker interactions can help clinicians decipher the pathophysiology of severe pneumonia and get better management for early extubation.ObjectivesThe objectives were to assess bronchoalveolar lavage fluid biomarker interactions of severely affected lung and their association in determining the early extubation success.MethodsIn this cross-sectional study, we consecutively evaluated 137 severe pneumonia patients. Patients who fulfilled inclusion criteria will undergo early bronchoscopy. The BALF was collected from the right and left lungs. Two Respirologist and Critical Illness consultants, plus one internist, determined the location for severely affected lung. Biomarker interactions in severely affected lung were analyzed. The primary outcome was the 19-days extubation.ResultsForty patients underwent bronchoscopy for BALF collection. The right lung was the predominant severely affected lung (28 patients). Eight patients survived and were successfully extubated within 19 days. There were significantly higher absolute CD4 + BALF cell counts (95% Confidence Interval = 9,24–49,50, p = 0,003) in the left lung and higher absolute CD4 + BALF cell counts (95% Confidence Interval = 9,00–29,75, p = 0,010) in the patients with extubation success and survived. Among all the patients with extubation success within 19 days, eight patients (100%) displayed the tendency of high CD4 levels (cutoff points median 16 cells/µL), low expression of alveolar macrophage function (cutoff points by ROC 756.5 MFI CD169), and low expression of IL-6 (cutoff points by ROC 369 pg/mg protein).ConclusionIn severely affected lung of severe pneumonia patients with early extubation success and survived, we found biomarker interactions marked by low alveolar macrophage function, low IL-6 levels, and high CD4 levels.Trial RegistrationThe study was registered at UMIN Clinical Trials Registry (UMIN-CTR) (registration number UMIN000046236), accessible at: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049197

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“…Em relação aos dados gasométricos entre GS e GI, ambos apresentaram valores semelhantes, logo não alcançaram significância estatística, alguns estudos sugerem que um baixo pH arterial, relação PaO2 / FiO2 menor que 300 mmHg e PaCO2 maior que 44 mmHg podem estar relacionados ao insucesso da extubação 2,3 . Todavia, outros estudos não encontraram valores estatísticos significantes 4,7,9 . Neste contexto pode-se levantar a hipótese do procedimento padrão hospitalar bem estabelecido e consolidado na instituição onde a pesquisa foi desenvolvida possuir um protocolo inicial para eleger pacientes ao teste de respiração espontânea, onde critérios gasométricos próximos da normalidade devem ser cumpridos.…”

Section: Discussionunclassified

“…Os testes de respiração espontânea (TRE) podem resultar em estresse cardiopulmonar e falha na extubação, uma vez que essa transição resulta em aumento das necessidades de energia muscular respiratória de acordo com o grau de sobrecarga respiratória (estresse respiratório) e a resultante demanda aumentada de oxigênio, que levam ao aumento do débito cardíaco (estresse cardiovascular). Este estresse cardiopulmonar induz inflamação sistêmica, através de diferentes sistemas biológicos associados ao sistema nervoso simpático e à liberação de catecolaminas 4 .…”

Section: Introductionunclassified

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Análise de marcadores inflamatórios como preditores de falha na extubação de pacientes em ventilação mecânica invasiva em unidades de terapia intensiva / Analysis of inflammatory markers as predictors of extubation failure in patients on invasive mechanical ventilation in intensive care units

Ferreira¹,

Borato²,

Cruz³

et al. 2021

BJDV

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Introdução: Um recurso imprescindível da UTI é a ventilação mecânica invasiva (VMI), utilizada em pacientes com insuficiência respiratória grave. O processo de transição da VMI para a respiração espontânea sofre influências de diferentes sistemas biológicos que podem levar a indução da inflamação sistêmica. Objetivo: explorar se marcadores inflamatórios clinicamente acessíveis são capazes de predizer o sucesso/insucesso de extubação em pacientes adultos. Métodos: pesquisa quantitativa, retrospectiva, longitudinal e analítica realizado em duas UTI adulto em um hospital universitário. A amostra foi dividida em grupo sucesso (GS) e grupo insucesso (GI). Coletou-se os resultados de exames laboratoriais, PCR, neutrófilos, linfócitos, leucócitos, promielócitos, mielócitos, metamielócitos e bastonetes, no período de 48 e 24 horas antes, no dia, 24 e 48 horas após a extubação. Resultados: Dos 147 pacientes, 39 (27%) falharam no processo de extubação. O GI apresentou maior tempo de internação em UTI com p<0,0001 e desfecho óbito durante internamento com p=0,03 (44%). A razão neutrófilos por linfócitos no GI apresentou valores elevados no dia, 24 e 48 horas após a extubação comparados ao GS com p=0,0035, p=0,0005 e p<0,0001, respectivamente. O ponto de corte da RNL no dia da extubação para prever o insucesso foi >6,9, com sensibilidade de 74,4% (IC 95% 57,9 a 86,9), especificidade de 58,5% (IC 95% 48,5 -68,0). Conclusão: A RNL emergiu como um marcador inflamatório eficaz, simples e de fácil obtenção, sugere-se que seja considerada por profissionais da saúde no dia da extubação como potencial preditor de insucesso e avaliada nas 48 horas subsequentes ao processo.Palavras-chave: Inflamação. Mediadores inflamatórios. Extubação das vias aéreas. Desmame do Ventilador.

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Evaluation of systemic inflammation in patients being weaned from mechanical ventilation

Cited by 10 publications

References 27 publications

Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation

Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation

Low Alveolar Macrophage Function, Low IL-6, and High CD4 Cell Count Interaction in BALF of Severe Pneumonia Patients with Extubation Success

Análise de marcadores inflamatórios como preditores de falha na extubação de pacientes em ventilação mecânica invasiva em unidades de terapia intensiva / Analysis of inflammatory markers as predictors of extubation failure in patients on invasive mechanical ventilation in intensive care units

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