Exhaled Breath Condensate in Mechanically Ventilated Brain-injured Patients with No Lung Injury or Sepsis

Korovesi, Ioanna; Papadomichelakis, Evangelos; Orfanos, Stylianos E.; Giamarellos‐Bourboulis, Evangelos J.; Livaditi, Olga; Πελεκάνου, Αιμιλία; Sotiropoulou, Christina; Koutsoukou, Antonia; Dimopoulou, Ioanna; Ekonomidou, Foteini; Psevdi, Ekaterini; Armaganidis, Apostolos; Roussos, Charis; Marczin, Nándor; Κοτανίδου, Αναστασία

doi:10.1097/aln.0b013e31820d84db

Cited by 24 publications

(45 citation statements)

References 51 publications

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“…Cytokines have been measured in EBC samples 2,21,26 . Our low detection rate is similar to findings in other studies in healthy patients ventilated during surgery 2 and reinforces the normal pulmonary status of our study patients.…”

Section: Discussionmentioning

confidence: 99%

“…The levels of TNFα and IL-8 in BAL also increased in ICU patients without ARDS ventilated with V T 10-12 mL/kg PBW for 12 h 3 compared to those ventilated with V T 5-7mL/kg PBW and similar PEEP. The antiinflammatory cytokine IL-10 was affected by ventilatory settings and ventilation duration in brain-injured patients 2 and used for functional repair of human donor lungs 29 . IL-11 has a protective role against murine hyperoxia-induced DNA fragmentation and lung injury 30,31 .…”

Section: Introductionmentioning

confidence: 99%

“…The nitrite and nitrate levels in exhaled breath condensate (EBC), representing the metabolism of nitric oxide in the lung, have been measured frequently for assessing lung injury in patients breathing spontaneously or ventilated in the ICU 2,6,21,22 and after cardiothoracic surgery [23][24][25] . Nitrite concentration in the EBC showed a positive correlation with V T in ICU patients with or without ARDS 6 , and with the degree of lung overdistention in chronic obstructive pulmonary disease (COPD) patients 26 .…”

Section: Introductionmentioning

confidence: 99%

“…Large tidal volumes (V T ) contribute to and worsen the acute respiratory distress syndrome (ARDS) in Intensive Care Unit (ICU) patients after hours or days of ventilation [1][2][3][4][5][6][7][8] . Recent studies suggest intraoperative ventilation settings affect postoperative pulmonary outcomes 1,[9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients With Healthy Lungs

Fernandez-Bustamante

Klawitter

Repine

et al. 2015

Survey of Anesthesiology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients With Healthy Lungs

Fernandez-Bustamante

Klawitter

Repine

et al. 2015

Survey of Anesthesiology

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“…Characteristic changes in lung mechanics, suggesting subclinical pulmonary inflammation, also developed before the patients became eligible to be organ donors. 7 Fisher et al 8 have shown that acute inflammation in the donor lung with elevated levels of interleukin 8 in donor bronchoalveolar lavage (BAL) is important in determining early outcomes after human lung transplantation. 9 These observations have subsequently been reproduced elsewhere in the world.…”

Section: Impact Of Donor Lung Injurymentioning

confidence: 99%

An observational study of Donor Ex Vivo Lung Perfusion in UK lung transplantation: DEVELOP-UK

Fisher

Andreasson

Chrysos

et al. 2016

Health Technol Assess

Self Cite

112

117

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BackgroundMany patients awaiting lung transplantation die before a donor organ becomes available. Ex vivo lung perfusion (EVLP) allows initially unusable donor lungs to be assessed and reconditioned for clinical use.ObjectiveThe objective of the Donor Ex Vivo Lung Perfusion in UK lung transplantation study was to evaluate the clinical effectiveness and cost-effectiveness of EVLP in increasing UK lung transplant activity.DesignA multicentre, unblinded, non-randomised, non-inferiority observational study to compare transplant outcomes between EVLP-assessed and standard donor lungs.SettingMulticentre study involving all five UK officially designated NHS adult lung transplant centres.ParticipantsPatients aged ≥ 18 years with advanced lung disease accepted onto the lung transplant waiting list.InterventionThe study intervention was EVLP assessment of donor lungs before determining suitability for transplantation.Main outcome measuresThe primary outcome measure was survival during the first 12 months following lung transplantation. Secondary outcome measures were patient-centred outcomes that are influenced by the effectiveness of lung transplantation and that contribute to the health-care costs.ResultsLungs from 53 donors unsuitable for standard transplant were assessed with EVLP, of which 18 (34%) were subsequently transplanted. A total of 184 participants received standard donor lungs. Owing to the early closure of the study, a non-inferiority analysis was not conducted. The Kaplan–Meier estimate of survival at 12 months was 0.67 [95% confidence interval (CI) 0.40 to 0.83] for the EVLP arm and 0.80 (95% CI 0.74 to 0.85) for the standard arm. The hazard ratio for overall 12-month survival in the EVLP arm relative to the standard arm was 1.96 (95% CI 0.83 to 4.67). Patients in the EVLP arm required ventilation for a longer period and stayed longer in an intensive therapy unit (ITU) than patients in the standard arm, but duration of overall hospital stay was similar in both groups. There was a higher rate of very early grade 3 primary graft dysfunction (PGD) in the EVLP arm, but rates of PGD did not differ between groups after 72 hours. The requirement for extracorporeal membrane oxygenation (ECMO) support was higher in the EVLP arm (7/18, 38.8%) than in the standard arm (6/184, 3.2%). There were no major differences in rates of chest radiograph abnormalities, infection, lung function or rejection by 12 months. The cost of EVLP transplants is approximately £35,000 higher than the cost of standard transplants, as a result of the cost of the EVLP procedure, and the increased ECMO use and ITU stay. Predictors of cost were quality of life on joining the waiting list, type of transplant and number of lungs transplanted. An exploratory model comparing a NHS lung transplant service that includes EVLP and standard lung transplants with one including only standard lung transplants resulted in an incremental cost-effectiveness ratio of £73,000. Interviews showed that patients had a good understanding of the need for, and the processes of, EVLP. If EVLP can increase the number of usable donor lungs and reduce waiting, it is likely to be acceptable to those waiting for lung transplantation. Study limitations include small numbers in the EVLP arm, limiting analysis to descriptive statistics and the EVLP protocol change during the study.ConclusionsOverall, one-third of donor lungs subjected to EVLP were deemed suitable for transplant. Estimated survival over 12 months was lower than in the standard group, but the data were also consistent with no difference in survival between groups. Patients receiving these additional transplants experience a higher rate of early graft injury and need for unplanned ECMO support, at increased cost. The small number of participants in the EVLP arm because of early study termination limits the robustness of these conclusions. The reason for the increased PGD rates, high ECMO requirement and possible differences in lung injury between EVLP protocols needs evaluation.Trial registrationCurrent Controlled Trials ISRCTN44922411.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 85. See the NIHR Journals Library website for further project information.

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Pulmonary-Respiratory Medicine

2001

JAMA

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Exhaled Breath Condensate in Mechanically Ventilated Brain-injured Patients with No Lung Injury or Sepsis

Cited by 24 publications

References 51 publications

Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients With Healthy Lungs

Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients With Healthy Lungs

An observational study of Donor Ex Vivo Lung Perfusion in UK lung transplantation: DEVELOP-UK

Pulmonary-Respiratory Medicine

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