Abstract
A major problem of the techniques used for quantifying endotoxin levels has been their low sensitivity. To address this problem, a diagnostic kit called Endotoxin Activity Assay (EAATM) was developed. The degree of lung injury must be determined when formulating treatment strategies for patients with sepsis and prognosticating the outcome of this condition. Based on the observations described above, we hypothesize that endotoxin can serve as an important biomarker in evaluating lung injury. Currently, lung injuries in patients with septic shock or ARDS can be assessed by cardiorespiratory monitoring. One such monitoring system is called Pulse index Continuous Cardiac Output (PiCCO). It measures cardiac output (CO) using a thermodilution technique that employs a cold thermal indicator. It then calculates CO per beat using pulse contour analysis. Importantly, PiCCO can also measure extravascular lung water (EVLW) and the pulmonary vascular permeability index (PVPI) that reflect the severity of lung injury. PVPI was significantly higher in patients with high EAA levels than in those with normal EAA levels (3.55 ± 0.48 vs. 1.99 ± 0.68, p = 0.0029). In addition, the patient group with high PCT levels showed significantly lower cardiac indices than the group with normal PCT levels (3.40 ± 1.05 vs. 4.80 ± 0.39, p = 0.0325). he results described above indicate that the EAA level is closely correlated with the degree of lung injury assessed by the PiCCO monitor. This suggests that EAA could also be used as a valuable tool in monitoring lung injury.
Highlights
The current concept of acute respiratory distress syndrome (ARDS) is a pathological response of the lung to an insult(s)
This article recognized that ARDS is a group of related pathological abnormalities in the lung initiated by a wide variety of different insults, such as sepsis, trauma and aspiration of gastric contents
The Committee recommended that ARDS be defined as “a syndrome of inflammation and increased permeability of the pulmonary capillaries caused by an insult(s).”
Summary
The current concept of acute respiratory distress syndrome (ARDS) is a pathological response of the lung to an insult(s). When the impairment of oxygenation was less severe (i.e., PaO2/FiO2 201 300), the syndrome was classified as acute lung injury (ALI) This definition of ARDS remained unchanged until 2012, when it was further refined and given the name “Berlin definition.”. According to the Berlin definition, ARDS is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue with the presence of bilateral opacities consistent with pulmonary edema. Another major change in the Berlin definition was that the term “acute lung injury (ALI)” was abandoned, eliminating the confusion derived from the previous AECC criteria[4]
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