Safety and feasibility of exhaled breath condensate collection in ventilated infants and children

Abstract

The aim of this study was to develop a technique for the collection of exhaled breath condensate (EBC) from ventilated children and assess its safety and feasibility. Collection of EBC is used to investigate markers of oxidative stress in the lower airway. No studies have assessed its safety in ventilated children.An in vitro model was developed by connecting a ventilator to an artificial lung; 14 clinical and ventilatory parameters were measured during EBC collection from ventilated children. Levels of 8-isoprostane were measured following collection with and without humidification of the inhaled gas.Amount of water vapour collected was linearly related to time and to minute ventilation in the in vitro model. EBC collections (n568) were made from ventilated children. In the nonhumidified group, the mean (range) positive end-expiratory pressure increased by 4.1% (2.8-5.5%) and the peak inspiratory flow decreased by 6.1% (11.0-1.3%) during collection. Detectable levels of 8-isoprostane were only found in 10 out of 18 nonhumidified EBC samples (median (range) 4.7 pg?mL -1 (0-5.8)).Collection of exhaled breath condensate from ventilated infants and children is feasible and safe. Discontinuation of humidification is likely to be important in standardising the measurement of inflammatory parameters in exhaled breath condensate collected from ventilated children.

Exhaled Breath Condensate Purines Correlate With Lung Function In Infants And Preschoolers

“…Furthermore, many previously described methods for EBC collection in this age group rely on novel devices developed at the institution conducting the study, limiting the ability to generalize methods [8][9][10][11] . In addition, the small volumes of EBC recovered coupled with the low concentrations of biomarkers make detection challenging 5 .…”

Novel end points for clinical trials in young children with cystic fibrosis

“…Several studies have demonstrated that EBC can be collected from infants sedated for lung function testing (138, 139), and a recent investigation demonstrated that EBC purines correlate with infant lung function measures (140). Further study will be required to determine whether the EBC approach can be successfully applied to infants and young children.…”

Exhaled breath condensate collection in the mechanically ventilated patient

“…Maintenance of the device is also more time consuming because the device requires cleaning between uses. In order to adapt the ECoScreen for use in mechanically ventilated patients, additional conduits were needed to attach the device to the expiratory circuit (3, 11, 13, 14, 16, 29) (Figure 3). The ECoScreenI device is no longer being manufactured.…”

“…It is derived from aerosolized non-volatile particles contained in fluid lining the airway, volatile water-soluble molecules that have been aerosolized and condensed, and distilled water from moisture within the airway itself (1). EBC can safely be collected from both actively participating patients breathing on their own, or during mechanical ventilation by placing a collection device in-line with the expiratory circuit of the ventilator (2, 3). …”

“…Studies have successfully monitored pH in mechanically ventilated patients, suggesting possible correlation with pro-inflammatory cytokines and overall inflammation (2, 11). Myeloperoxidase (MPO) and 8-isoprostane levels have been measured in multiple studies and were elevated in one looking at mechanically ventilated patients with severe pulmonary infection, suggesting inflammation due to increased reactive oxygen species (ROS) (3, 12, 13, 14, 15). Studies examining intubated patients with inflammatory lung diseases (ALI/ARDS) and COPD, found higher levels of all investigated cytokines (IL-1β, IL-6,IL-8, IL-10, TNFα, IL-12p70) in comparison to healthy smoking and non-smoking volunteers (9, 16).…”