Exhaled breath condensate acidification in acute lung injury.
Lung injury in ventilated lungs may occur due to local or systemic disease and is usually caused by or accompanied by inflammatory processes. Recently, acidification of exhaled breath condensate pH (EBC-pH) has been suggested as marker of inflammation in airway disease. We investigated pH, ammonia, Lactate, pCO2, HCO3-, IL-6 and IL-8 in EBC of 35 ventilated patients (AECC-classification: ARDS: 15, ALI: 12, no lung injury: 8). EBC-pH was decreased in ventilated patients compared to volunteers (5.85 +/- 0.32 vs. 7.46 +/- 0.48; P < 0.0001). NH4+, lactate, HCO3-, pCO2, IL-6 and IL-8 were analyzed in EBC and correlated with EBC-pH. We observed correlations of EBC-pH with markers of local (EBC IL-6: r = -0.71, P < 0.0001, EBC IL-8: r = -0.68, P < 0.0001) but not of systemic inflammation (serum IL-6, serum IL-8) and with indices of severity of lung injury (Murray's Lung Injury Severity Score; r = -0.73, P < 0.0001, paO2/FiO2; r = 0.54, P < 0.001). Among factors potentially contributing to pH of EBC, EBC-lactate and EBC-NH4+ were found to correlate with EBC-pH. Inflammation-induced disturbances of regulatory mechanisms, such as glutaminase systems may result in EBC acidification. EBC-pH is suggested to represent a marker of acute lung injury caused by or accompanied by pulmonary inflammation.
Gessner
Christian
C
Department of Internal Medicine, Pulmonary Medicine, Critical Care and Cardiology, University of Leipzig, Johannisallee 32, Leipzig 04103, Germany. gesc@medizin.uni-leipzig.de
Hammerschmidt
Stefan
S
Kuhn
Hartmut
H
Seyfarth
Hans-Jürgen
HJ
Sack
Ulrich
U
Engelmann
Lothar
L
Schauer
Joachim
J
Wirtz
Hubert
H
D000208:Acute Disease; D000641:Ammonia / Q000032:analysis; D000681:Amylases / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests / Q000379:methods; D002245:Carbon Dioxide / Q000032:analysis; D002255:Carbonic Acid / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007378:Interleukins / Q000032:analysis; D007773:Lactates / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis*; D012121:Respiration, Artificial / Q000009:adverse effects
D015415:Biomarkers; D007378:Interleukins; D007773:Lactates; D002245:Carbon Dioxide; D002255:Carbonic Acid; D000641:Ammonia; D000681:Amylases