Particle flow rate from the airways as fingerprint diagnostics in mechanical ventilation in the intensive care unit: a randomised controlled study

Abstract

IntroductionMechanical ventilation (MV) can be monitored by analysing particles in exhaled air as measured by particle flow rate (PFR). This could be a potential method of detecting ventilator induced lung injury (VILI) before changes in conventional parameters can be detected. The aim of this study was to investigate PFR during different ventilation modes in patients without lung pathology.MethodA prospective study was conducted on patients on MV in the cardiothoracic intensive care unit (ICU). A PExA 2.0 device was connected to the expiratory limb on the ventilator for continuous measurement of PFR in 30 patients randomised to either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) for 30 min including a recruitment manoeuvre (RM). PFR measurements were continued as the patients were transitioned to pressure regulated volume control (PRVC) and then pressure support ventilation (PSV) until extubation.ResultsPRVC resulted in significantly lower PFR while those on PSV had the highest PFR. The distribution of particles differed significantly between the different ventilation modes.ConclusionsMeasuring PFR is safe after cardiac surgery in the ICU and may constitute a novel method of continuously monitoring the small airways in real time. A low PFR during mechanical ventilation may correlate to a gentle ventilation strategy. PFR increases as the patient transitions from controlled MV to autonomous breathing, which most likely occurs as recruitment by the diaphragm opens up more distal airways. Different ventilation modes resulted in unique particle patterns and could be used as a fingerprint for the different ventilation modes.

Proteomic characteristics and diagnostic potential of exhaled breath particles in patients with COVID-19

“…Similarly, COV-NEG patients, meaning patients with respiratory symptoms, likewise presented with a slightly lower increase in particle concentrations suggestive of a disease-dependent variation in surfactant composition. Thus, EBP collection is a promising new method for monitoring pulmonary health status over the course of an infection and has previously been investigated in other diseases [ 25 , 26 ].…”

Integrin α10β1-selected mesenchymal stem cells reduced hypercoagulopathy in a porcine model of acute respiratory distress syndrome

“…LPS is used for ARDS animal models due to its specific targeting of alveolar type II cells and pulmonary surfactant, which also leads to damage that mimics the neutrophil response seen in human [ 22 , 23 ]. We have demonstrates the use of this sepsis-like injury state in previous porcine lung injury models [ 21 , 24 ]. This results in a reliable and consistent model of sepsis-like disease in animals without overwhelming septicaemia.…”

Exhaled phospholipid transfer protein and hepatocyte growth factor receptor in lung adenocarcinoma

“…The respiratory tract lining fluid (RTLF) covers the epithelial surfaces of the distal airways. As small airways and alveoli open and close, particles from the RTLF enter the large airways and are subsequently exhaled [ 16 ]. The particle flow from the airways is measured as the particle flow rate (PFR) of EBP, which are collected for subsequent analysis [ 14 , 15 , 17 ].…”