Abstract
Background : Medical tubing like ventilator endotracheal tubes ETT) contain several phthalate plasticizers in the polyvinyl chloride (PVC) matrix. Several phthalates are known for their human toxicities, but the effect of these in ventilator conditions are not studied. Methods : Medical grade ETT tubes were subjected to simulated ventilator conditions in vitro. The effluents were analyzed by mass spectrometry to identify specific phthalates. The toxicities of the effluent phthalates were analyzed by targeted metabolomics. Results : We determined biologically active levels of phthalates including diisononyl phthalate (DINP), Di-2- ethylhexyl phthalate (DEHP), and methyl ethylhexyl phthalate (MEHP), in ETT effluent fluids. Although these pthalates did not ellicit short-term acute pathologies, systematic global metabolomics of human lung cells incubated with pthalates in vitro revealed these phthalates modulate at least 12 discrete metabolic pathways including amino acid metabolism, energy metabolism and Th2 phenotype in immune cells. Conclusion : ETT- phthalates may present clinically relevant toxicities on patients under long term mechanical ventilation.
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