Abstract
BackgroundPreventing ventilator-associated lung injury (VALI) has become pivotal in mechanical ventilation of patients with acute lung injury (ALI) or its more severe form, acute respiratory distress syndrome (ARDS). In the present study we investigated whether plasma levels of lung-specific biological markers can be used to evaluate lung injury in patients with ALI/ARDS and patients without lung injury at onset of mechanical ventilation.MethodsPlasma levels of surfactant protein D (SP-D), Clara Cell protein (CC16), KL-6 and soluble receptor for advanced glycation end-products (sRAGE) were measured in plasma samples obtained from 36 patients - 16 patients who were intubated and mechanically ventilated because of ALI/ARDS and 20 patients without lung injury at the onset of mechanical ventilation and during conduct of the study. Patients were ventilated with either a lung-protective strategy using lower tidal volumes or a potentially injurious strategy using conventional tidal volumes. Levels of biological markers were measured retrospectively at baseline and after 2 days of mechanical ventilation.ResultsPlasma levels of CC16 and KL-6 were higher in ALI/ARDS patients at baseline as compared to patients without lung injury. SP-D and sRAGE levels were not significantly different between these patients. In ALI/ARDS patients, SP-D and KL-6 levels increased over time, which was attenuated by lung-protective mechanical ventilation using lower tidal volumes (P = 0.02 for both biological markers). In these patients, with either ventilation strategy no changes over time were observed for plasma levels of CC16 and sRAGE. In patients without lung injury, no changes of plasma levels of any of the measured biological markers were observed.ConclusionPlasma levels of SP-D and KL-6 rise with potentially injurious ventilator settings, and thus may serve as biological markers of VALI in patients with ALI/ARDS.
Highlights
Preventing ventilator-associated lung injury (VALI) has become pivotal in mechanical ventilation of patients with acute lung injury (ALI) or its more severe form, acute respiratory distress syndrome (ARDS)
While maximum airway pressures were significantly higher in both ALI/ARDS groups, tidal volumes and respiratory rates applied in patients without lung injury at onset of mechanical ventilation were comparable with those in patients in the lung-protective ALI/ARDS group
We investigated whether plasma levels of surfactant protein D (SP-D), CC16, KL-6 and soluble receptor for advanced glycation end-products (sRAGE) could be used for evaluation of lung injury in critically ill mechanically ventilated patients
Summary
Preventing ventilator-associated lung injury (VALI) has become pivotal in mechanical ventilation of patients with acute lung injury (ALI) or its more severe form, acute respiratory distress syndrome (ARDS). Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS) are life-threatening conditions with mortality rates up to 40% [1,2]. Clinical trials have demonstrated that non-protective forms of mechanical ventilation can cause additional pulmonary damage in patients with ALI/ARDS, Development of VALI is not recognizable and not always preventable. One strategy frequently used to assess development of VALI is measurement of bronchoalveolar lavage fluid levels of proteins involved in the pathophysiology of lung injury. Respiratory and hemodynamic complications associated with bronchoscopy and subsequent lavage may hamper routine use of local levels of biological markers
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