Exhaled breath condensate detects markers of pulmonary inflammation after cardiothoracic surgery.
Cardiac surgery using cardiopulmonary by-pass and, to a greater extent, lung resection, causes acute lung injury that is usually subclinical. Analysis of mediators in exhaled breath condensate is a promising means of monitoring inflammation in a variety of airway diseases but the contribution of the airway lining fluid from the lower respiratory tract is uncertain. We compared the analysis of markers of lung injury in exhaled breath condensate and bronchoalveolar lavage in endotracheally intubated patients before and after coronary artery bypass graft surgery with cardiopulmonary bypass and lobectomy. The neutrophil count and leukotriene B4 concentration in bronchoalveolar lavage fluid rose after coronary artery bypass graft surgery (p < 0.05), but there was no significant change in leukotriene B4, hydrogen peroxide, or hydrogen ion concentrations in exhaled breath condensate. By contrast, after lobectomy, the concentration in exhaled breath condensate of leukotriene B4, hydrogen peroxide and hydrogen ions rose significantly (p < 0.05). Exhaled breath condensate is a safe, noninvasive method of sampling the milieu of the distal lung and is sufficiently sensitive to detect markers of inflammation and oxidative stress in patients after lobectomy, but not after the milder insult associated with cardiac surgery.
Moloney
Edward D
ED
Unit of Critical Care and Thoracic Medicine, Imperial College London at the National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
Mumby
Sharon E
SE
Gajdocsi
Reka
R
Cranshaw
Julius H
JH
Kharitonov
Sergei A
SA
Quinlan
Gregory J
GJ
Griffiths
Mark J
MJ
D000368:Aged; D001944:Breath Tests; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D015237:Dinoprost / Q000031:analogs & derivatives*; D028441:F2-Isoprostanes / Q000032:analysis; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D007975:Leukotriene B4 / Q000032:analysis; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D028441:F2-Isoprostanes; D018836:Inflammation Mediators; D007975:Leukotriene B4; C075750:8-epi-prostaglandin F2alpha; D015237:Dinoprost