Bee Natalie, White Ruth, Petros Andy J
All authors: Pediatric and Neonatal Intensive Care Unit, J.M. Barrie Division, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.
Pediatr Crit Care Med. 2017 Aug;18(8):e327-e332. doi: 10.1097/PCC.0000000000001223.
There is increasing interest in hydrogen sulfide as a marker of pathologic conditions or predictors of outcome. We speculate that as hydrogen sulfide is a diffusible molecule, if there is an increase in plasma hydrogen sulfide in sepsis, it may accumulate in the alveolar space and be detected in exhaled gas. We wished to determine whether we could detect hydrogen sulfide in exhaled gases of ventilated children and neonates and if the levels changed in sepsis.
Prospective, observational study.
The study was conducted across three intensive care units, pediatric, neonatal and cardiac in a large tertiary children's hospital.
We studied ventilated children and neonates with sepsis, defined by having two or more systemic inflammatory response syndrome criteria and one organ failure or suspected infection. A control group of ventilated non-septic patients was also included.
A portable gas chromatograph (OralChroma; Envin Scientific, Chester, United Kingdom) was used to measure H2S in parts per billion.
A 1-2 mL sample of expired gas was taken from the endotracheal tube and analyzed. A repeat sample was taken after 30 minutes and a further single daily sample up to a maximum of 5 days or until the patient was extubated. WBC and C-reactive protein were measured around the time of gas sampling. Each group contained 20 subjects. Levels of H2S were significantly higher in septic patients (Mann Whitney U-test; p < 0.0001) and trended to control levels over five days. C- reactive protein levels were also significantly raised (p < 0.001) and mirrored the decrease in H2S levels.
Hydrogen sulfide can be detected in expired pulmonary gases in very low concentrations of parts per billion. Significantly higher levels are seen in septic patients compared with controls. The pattern of response was similar to that of C-reactive protein.
硫化氢作为病理状况的标志物或预后预测指标，其受关注程度日益增加。我们推测，由于硫化氢是一种可扩散分子，若脓毒症患者血浆硫化氢水平升高，它可能会积聚在肺泡腔并在呼出气体中被检测到。我们希望确定能否在接受机械通气的儿童和新生儿呼出气体中检测到硫化氢，以及其水平在脓毒症时是否会发生变化。
前瞻性观察性研究。
该研究在一家大型三级儿童医院的三个重症监护病房（儿科、新生儿科和心脏科）进行。
我们研究了接受机械通气的脓毒症儿童和新生儿，脓毒症定义为符合两条或更多全身炎症反应综合征标准且伴有一个器官功能衰竭或疑似感染。还纳入了一组接受机械通气的非脓毒症患者作为对照组。
使用便携式气相色谱仪（OralChroma；英国切斯特的Envin Scientific公司）以十亿分比为单位测量硫化氢。
从气管插管采集1 - 2毫升呼出气体样本并进行分析。30分钟后采集重复样本，此后每天采集一次单次样本，最长持续5天或直至患者拔管。在气体采样时测量白细胞和C反应蛋白。每组有20名受试者。脓毒症患者的硫化氢水平显著更高（曼-惠特尼U检验；p < 0.0001），并在五天内趋向于对照水平。C反应蛋白水平也显著升高（p < 0.001），且与硫化氢水平的下降情况相似。
在呼出的肺气体中能够检测到浓度极低（十亿分比）的硫化氢。与对照组相比，脓毒症患者的硫化氢水平显著更高。其反应模式与C反应蛋白相似。
