title: Plasma levels of sRAGE, loss of aeration and weaning failure in ICU patients: a prospective observational multicenter study.
abstract: BACKGROUND
  Postextubation distress after a successful spontaneous breathing trial (SBT) is associated with increased morbidity and mortality. Lung ultrasound determination of changes in lung aeration predicts weaning failure. It remains unknown whether this derecruitment is related to alveolar epithelial dysfunction or not.
  
  
  OBJECTIVE
  To verify whether lung alveolar type I epithelial cell injury marker sRAGE (soluble form of the receptor for advanced glycation end-products) is predictive of postextubation distress and weaning failure or not, and to verify whether plasma sRAGE levels can be related to lung derecruitment during the process of weaning from mechanical ventilation or not. INTERVENTIONS MEASUREMENTS: 88 patients from 2 intensive care units were included in this observational prospective study. Plasma sRAGE levels were measured in duplicate by ELISA before, at the end of a 60-minute SBT, and 4 hours after extubation. To quantify lung aeration, a lung ultrasound score was calculated.
  
  
  RESULTS
  34% of extubated patients experienced postextubation distress. Patients with or without postextubation distress had comparable sRAGE levels before SBT, after SBT, and 4 hours after extubation. In patients with postextubation distress, sRAGE levels were not predictive of the need for mechanical ventilation. sRAGE levels were not associated with lung aeration as assessed by echography. Patients who succeeded SBT (86%) and those who failed (14%) had no differences in sRAGE levels, before (median 1111 vs 1021 pg/mL, p = 0,87) and at the end of SBT (1165 vs 1038 pg/mL, p = 0.74).
  
  
  CONCLUSIONS
  Plasma levels of sRAGE do not predict postextubation distress or SBT failure/success in patients weaning from mechanical ventilation. Lung aeration loss during a successful weaning trial predicts postextubation distress, but may not be evaluable by plasma levels of sRAGE, a marker of alveolar type I epithelial cell injury.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01098773.
authors.affiliation: Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Estaing Hospital, CHU Clermont-Ferrand, Université d'Auvergne Clermont Ferrand 1, Clermont-Ferrand, France. mjabaudon@chu-clermontferrand.fr
authors.forename: Matthieu
authors.initials: M
authors.lastname: Jabaudon
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.forename: Alexis
authors.initials: A
authors.lastname: Soummer
authors.forename: Laurence
authors.initials: L
authors.lastname: Roszyk
authors.forename: Renaud
authors.initials: R
authors.lastname: Guérin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Futier
authors.forename: Qin
authors.initials: Q
authors.lastname: Lu
authors.forename: Jean-Etienne
authors.initials: JE
authors.lastname: Bazin
authors.forename: Vincent
authors.initials: V
authors.lastname: Sapin
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Rouby
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000097:blood*; D012119:Respiration; D012121:Respiration, Artificial; D014463:Ultrasonography; D015300:Ventilator Weaning
chemical_list: D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic