Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study

Abstract

Background: It can be a clinical challenge to distinguish inflammation from infection in critically ill patients. Therefore, valid and conclusive surrogate markers for infections are desired. Nitric oxide (NO) might be that marker since concentrations of exhaled NO have shown to change in the presence of various diseases.
This observational, prospective, single-center feasibility study aimed to investigate if fractional exhaled NO (FeNO) can be measured in intubated patients with or without infection, pneumonia and septic shock in a standardized, reliable setting.
Methods: 20 intubated patients in the intensive care unit (ICU) were included for analysis. FeNO mean values were measured in the endotracheal tube via the suction channel using a chemiluminescence based analyzer. 
Results: We developed a pragmatic method to measure FeNO repeatedly and reliably in intubated patients using a chemiluminescence based analyzer. We found a median of 0.98 (0.59-1.44) FeNO mean (ppb) in exhaled breath from all 20 intubated patient. Intubated patient with suspected infection had a significantly lower median FENO mean compared with the intubated patients without suspected infection. Similarly did patients with septic shock demonstrate a significantly lower median FENO mean than without septic shock. We found no statistical difference in median FeNO mean for intubated patients with pneumonia.
Conclusion: It was feasible to measure FeNO in intubated patients in the ICU. Our results indicate decreased levels of FeNO in infected intubated patients in the ICU. The study was not powered to provide firm conclusions, so larger trials are needed to confirm the results and to prove FeNO as a useful biomarker for distinguishment between infection and inflammation in the ICU.

PEAK End-Tidal NO as a biomarker for investigating the effect of different OLV strategies on lung injury and inflammation response.

“…The ventilated lung unbalances the production and consumption of NO by destroying the endothelium and inducing in ammatory and oxidative stress; the change in NO indicates lung injury. Currently, exhaled breath condensate nitrite and nitrate, the metabolism of NO in the lungs, has been measured frequently for assessing lung injury in ventilated patients [10][11][12]. As a more direct index, eNO collected during ventilation may be a new and convenient in ammatory marker of lung injury.…”