Department of Anesthesiology, University Hospital of Munich-Campus Großhadern, Ludwig-Maximilians-University of Munich, 81366 Munich, Germany.
V&F Analyse-und Messtechnik GmbH, Andreas Hofer Strasse 15, 6067 Absam, Austria.
Molecules. 2020 Dec 31;26(1):145. doi: 10.3390/molecules26010145.
Oxidative stress-induced lipid peroxidation (LPO) due to neutrophil-derived reactive oxygen species plays a key role in the early stage of the acute respiratory distress syndrome (ARDS). Monitoring of oxidative stress in this patient population is of great interest, and, ideally, this can be done noninvasively. Recently, propionaldehyde, a volatile chemical compound (VOC) released during LPO, was identified in the breath of lung transplant recipients as a marker of oxidative stress. The aim of the present study was to identify if markers of oxidative stress appear in the oxygenator outflow gas of patients with severe ARDS treated with veno-venous extracorporeal membrane oxygenation (ECMO).
The present study included patients with severe ARDS treated with veno-venous ECMO. Concentrations of acetone, isoprene, and propionaldehyde were measured in inspiratory air, exhaled breath, and oxygenator inflow and outflow gas at corresponding time points. Ion-molecule reaction mass spectrometry was used to measure VOCs in a sequential order within the first 24 h and on day three after ECMO initiation.
Nine patients (5 female, 4 male; age = 42.1 ± 12.2 year) with ARDS and already established ECMO therapy (pre-ECMO PaO/FiO = 44.0 ± 11.5 mmHg) were included into analysis. VOCs appeared in comparable amounts in breath and oxygenator outflow gas (acetone: 838 (422-7632) vs. 1114 (501-4916) ppbv; isoprene: 53.7 (19.5-244) vs. 48.7 (37.9-108) ppbv; propionaldehyde: 53.7 (32.1-82.2) vs. 42.9 (24.8-122) ppbv). Concentrations of acetone, isoprene, and propionaldehyde in breath and oxygenator outflow gas showed a parallel course with time.
Acetone, isoprene, and propionaldehyde appear in breath and oxygenator outflow gas in comparable amounts. This allows for the measurement of these VOCs in a critically ill patient population via the ECMO oxygenator outflow gas without the need of ventilator circuit manipulation.
中性粒细胞衍生的活性氧引起的氧化应激诱导的脂质过氧化 (LPO) 在急性呼吸窘迫综合征 (ARDS) 的早期阶段发挥关键作用。监测该患者人群中的氧化应激非常重要，理想情况下，可以进行非侵入性监测。最近，丙醛作为 LPO 过程中释放的挥发性化学化合物 (VOC)，在肺移植受者的呼吸中被鉴定为氧化应激的标志物。本研究的目的是确定在接受静脉-静脉体外膜肺氧合 (ECMO) 治疗的严重 ARDS 患者的体外氧合器流出气体中是否出现氧化应激标志物。
本研究纳入了接受静脉-静脉 ECMO 治疗的严重 ARDS 患者。在相应时间点测量吸气空气、呼气和体外氧合器流入和流出气体中的丙酮、异戊二烯和丙醛浓度。离子-分子反应质谱法用于在 ECMO 启动后的前 24 小时内和第三天按顺序测量 VOC。
共纳入 9 例 ARDS 患者（5 例女性，4 例男性；年龄=42.1±12.2 岁），并已接受 ECMO 治疗（ECMO 前 PaO/FiO=44.0±11.5mmHg）。VOC 在呼吸和体外氧合器流出气体中以相似的量出现（丙酮：838（422-7632）与 1114（501-4916）ppbv；异戊二烯：53.7（19.5-244）与 48.7（37.9-108）ppbv；丙醛：53.7（32.1-82.2）与 42.9（24.8-122）ppbv）。呼吸和体外氧合器流出气体中丙酮、异戊二烯和丙醛的浓度随时间呈平行变化。
丙酮、异戊二烯和丙醛在呼吸和体外氧合器流出气体中以相似的量出现。这允许通过 ECMO 氧合器流出气体测量这些 VOC，而无需对呼吸机回路进行操作。
