title: Alveolar fluid clearance is faster in women with acute lung injury compared to men.
abstract: OBJECTIVE
  Studies suggest that there is a sex difference in the development and outcomes of acute lung injury (ALI). Few studies have directly addressed the association of sex and alveolar fluid clearance (AFC), a process that is critical to ALI resolution.
  
  
  METHODS
  To test the hypothesis that female sex is associated with an increased AFC rate, we measured AFC rates in 150 mechanically ventilated patients with acute pulmonary edema and a pulmonary edema fluid-to-plasma protein ratio (EF/PL) diagnostic of low permeability (EF/PL <0.65, n = 69) or high permeability (EF/PL ≥0.65, n = 81) edema. We measured protein concentration in serial samples of undiluted EF collected within 6 hours of intubation and calculated net rate of AFC. In addition, plasma levels of receptor for advanced glycation end products were measured as a surrogate marker for alveolar epithelial injury.
  
  
  RESULTS
  In patients with ALI, women had higher rates of net AFC at 4 hours compared to men (11.9% per hour vs 4.3% per hour, P = .017) and more women had maximal rates of AFC. There were no differences in circulating levels of receptor for advanced glycation end products between men and women.
  
  
  CONCLUSIONS
  These findings may have significant implications for future ALI studies and potential therapies.
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2650, USA. julie.bastarache@vanderbilt.edu
authors.forename: Julie A
authors.initials: JA
authors.lastname: Bastarache
authors.forename: Thida
authors.initials: T
authors.lastname: Ong
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
mesh_terms: D055371:Acute Lung Injury / Q000378:metabolism*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001826:Body Fluids / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000378:metabolism*; D011654:Pulmonary Edema / Q000378:metabolism*; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000097:blood; D012121:Respiration, Artificial; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic