Biological markers of lung injury before and after the institution of positive pressure ventilation in patients with acute lung injuryReportar como inadecuado

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Critical Care

, 10:R126

First Online: 06 September 2006Received: 20 June 2006Revised: 14 August 2006Accepted: 06 September 2006


BackgroundSeveral biological markers of lung injury are predictors of morbidity and mortality in patients with acute lung injury ALI. The low tidal volume lung-protective ventilation strategy is associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. The primary objective of this study was to test whether the institution of lung-protective positive pressure ventilation in spontaneously ventilating patients with ALI exacerbates pre-existing lung injury by using measurements of biomarkers of lung injury before and after intubation.

Materials and methodsA prospective observational cohort study was conducted in the intensive care unit of a tertiary care university hospital. Twenty-five intubated, mechanically ventilated patients with ALI were enrolled. Physiologic data and serum samples were collected within 6 hours before intubation and at two different time points within the first 24 hours after intubation to measure the concentration of interleukin IL-6, IL-8, intercellular adhesion molecule 1 ICAM-1, and von Willebrand factor vWF. The differences in biomarker levels before and after intubation were analysed using repeated measures analysis of variance and a paired t test with correction for multiple comparisons.

ResultsBefore endotracheal intubation, all of the biological markers IL-8, IL-6, ICAM-1, and vWF were elevated in the spontaneously breathing patients with ALI. After intubation and the institution of positive pressure ventilation tidal volume 7 to 8 ml-kg per ideal body weight, none of the biological markers was significantly increased at either an early 3 ± 2 hours or later 21 ± 5 hours time point. However, the levels of IL-8 were significantly decreased at the later time point 21 ± 5 hours after intubation. During the 24-hour period after intubation, the PaO2-FiO2 partial pressure of arterial oxygen-fraction of the inspired oxygen ratio significantly increased and the plateau airway pressure significantly decreased.

ConclusionLevels of IL-8, IL-6, vWF, and ICAM-1 are elevated in spontaneously ventilating patients with ALI prior to endotracheal intubation. The institution of a lung-protective ventilation strategy with positive pressure ventilation does not further increase the levels of biological markers of lung injury. The results suggest that the institution of a lung-protective positive pressure ventilation strategy does not worsen the pre-existing lung injury in most patients with ALI.

AbbreviationsALIALI = acute lung injury

ARDSARDS = acute respiratory distress syndrome


BALBAL = bronchoalveolar lavage

FiOFiO2 = fraction of the inspired oxygen

ICAM-1 ICAM-1 = intercellular adhesion molecule-1

ILIL = interleukin

PaOPaO2 = partial pressure of arterial oxygen

PEEPPEEP = positive end-expiratory pressure

SP-DSP-D = surfactant protein D

sTNFrI-IIsTNFrI-II = soluble tumour necrosis factor receptor I-II

TNF-αTNF-α = tumour necrosis factor-α

vWFvWF = von Willebrand factor.

Electronic supplementary materialThe online version of this article doi:10.1186-cc5037 contains supplementary material, which is available to authorized users.

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Autor: Magda Cepkova - Sandra Brady - Anil Sapru - Michael A Matthay - Gwynne Church


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