1 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and.
2 Division of Allergy, Pulmonary, and Critical Care Medicine, University of Alabama at Birmingham Medical Center, Birmingham, Alabama; and.
Am J Respir Crit Care Med. 2018 Apr 15;197(8):1027-1035. doi: 10.1164/rccm.201707-1474OC.
A major barrier to a more complete understanding of acute respiratory distress syndrome (ARDS) pathophysiology is the inability to sample the distal airspace of patients with ARDS. The heat moisture exchanger (HME) filter is an inline bacteriostatic sponge that collects exhaled moisture from the lungs of mechanically ventilated patients.
To test the hypothesis that HME filter fluid (HMEF) represents the distal airspace fluid in patients with ARDS.
Samples of HMEF were collected from 37 patients with acute pulmonary edema (either from ARDS or hydrostatic causes [HYDRO; control subjects]). Concurrent undiluted pulmonary edema fluid (EF) and HMEF were collected from six patients. HMEF from 11 patients (8 ARDS and 3 HYDRO) were analyzed by liquid chromatography-coupled tandem mass spectometry. Total protein (bicinchoninic acid assay), MMP-9 (matrix metalloproteinase-9), and MPO (myeloperoxidase) (ELISA) were measured in 29 subjects with ARDS and 5 subjects with HYDRO. SP-D (surfactant protein-D), RAGE (receptor for advanced glycation end-products) (ELISA), and cytokines (IL-1β, IL-6, IL-8, and tumor necrosis factor-α) (electrochemiluminescent assays) were measured in six concurrent HMEF and EF samples.
Liquid chromatography-coupled tandem mass spectrometry on concurrent EF and HMEF samples from four patients revealed similar base peak intensities and m/z values indicating similar protein composition. There were 21 significantly elevated proteins in HMEF from patients with ARDS versus HYDRO. Eight proteins measured in concurrent EF and HMEF from six patients were highly correlated. In HMEF, total protein and MMP-9 were significantly higher in ARDS than in HYDRO.
These data suggest that HMEF is a novel, noninvasive method to accurately sample the distal airspace in patients with ARDS.
无法从急性呼吸窘迫综合征（ARDS）患者的远端气道取样，这是对其病理生理学进行更全面了解的主要障碍。热湿交换器（HME）过滤器是一种在线抑菌海绵，可从机械通气患者的肺部收集呼出的水分。
验证 HME 过滤器液体（HMEF）代表 ARDS 患者远端气道液的假说。
从 37 例急性肺水肿患者（ARDS 或静水压力引起的[HYDRO；对照）中收集 HMEF 样本。从 6 例患者中同时收集未稀释的肺水肿液（EF）和 HMEF。对 11 例患者（8 例 ARDS 和 3 例 HYDRO）的 HMEF 进行液相色谱-串联质谱分析。在 29 例 ARDS 患者和 5 例 HYDRO 患者中测量总蛋白（二辛可宁酸法）、MMP-9（基质金属蛋白酶-9）和 MPO（髓过氧化物酶）（ELISA）。在 6 例同时的 HMEF 和 EF 样本中测量 SP-D（表面活性蛋白-D）、RAGE（晚期糖基化终产物受体）（ELISA）和细胞因子（IL-1β、IL-6、IL-8 和肿瘤坏死因子-α）（电化学发光测定法）。
对 4 例患者同时的 EF 和 HMEF 样本进行液相色谱-串联质谱分析，发现相似的基峰强度和 m/z 值，表明具有相似的蛋白质组成。在 ARDS 患者的 HMEF 中有 21 种显著升高的蛋白质，与 HYDRO 相比。在 6 例患者同时的 EF 和 HMEF 中测量的 8 种蛋白质高度相关。在 HMEF 中，ARDS 患者的总蛋白和 MMP-9 明显高于 HYDRO。
这些数据表明，HMEF 是一种新颖的、非侵入性的方法，可以准确地从 ARDS 患者的远端气道取样。
