Exhaled-breath condensate pH can be safely and continuously monitored in mechanically ventilated patients.
BACKGROUND
Airway inflammation in acute and chronic respiratory diseases is characterized in part by abnormal pH in airway-lining fluid. The pH of exhaled-breath condensate (EBC) is low (acidic) in various pulmonary inflammatory diseases, including asthma, chronic obstructive pulmonary disease, cystic fibrosis, pneumonia, and acute respiratory distress syndrome. Because the time course of pH changes in the airway is not yet clear, we aimed to develop a method for frequent and intensive EBC pH data collection in mechanically ventilated patients.


METHODS
We examined the collection, gas-standardizing (CO2 removal), and continuous monitoring of pH of EBC from the expiratory port of a Servo-i ventilator with mechanically ventilated patients. We developed a condensing device that attaches to the exhaust port and is chilled by an electric cooling system. We built a 2-chamber gas-standardization and pH-measuring device that attaches to the condensing system and records pH every 6 s. After safety testing, we enrolled mechanically ventilated patients (with diverse reasons for requiring ventilatory support) for up to 96 h of continuous EBC pH condensimetry.


RESULTS
The pressure, volume, and flow of the ventilator attached to a test lung were unchanged by application of the condensimeter, at various flows (2-120 L/min) and ventilator settings. We monitored 19 pediatric patients for 6-96 h. The pH of the accumulated EBC in the storage container correlated with the geometric mean of all the pH data points from the condensimeter during the recording period (r2 = -0.95, p < 0.001), which internally validated that the condensimetry system provides accurate, well gas-standardized readings for up to 96 h. The EBC pH values were similar to published reports of single samples. The EBC pH became more acidic during clinical deterioration and normalized with recovery.


CONCLUSIONS
Continuous monitoring of EBC pH from the ventilator exhaust port is safely achievable and reliably provides data that may become useful in monitoring critically ill patients.
Walsh
Brian K
BK
Department of Pediatrics, University of Virginia, Charlottesville, VA 22908, USA. bkw2j@virginia.edu
Mackey
Dan J
DJ
Pajewski
Thomas
T
Yu
Yuanlin
Y
Gaston
Benjamin M
BM
Hunt
John F
JF
D000293:Adolescent; D001944:Breath Tests / Q000379:methods*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D045853:Exhalation; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012129:Respiratory Function Tests