title: Elevation of procalcitonin after implantation of an interventional lung assist device in critically ill patients.
abstract: A pumpless interventional arteriovenous lung assist device (iLA) facilitates the removal of carbon dioxide from the blood and is used as part of the lung-protective ventilation strategy in patients with acute respiratory distress syndrome (ARDS). In case of bacterial infection, delayed antimicrobial therapy increases the mortality in this group of high-risk critically ill patients, whereas overtreatment promotes bacterial resistance and leads to increased drug toxicity and costs. Besides clinical signs and symptoms, antimicrobial treatment is based on the kinetics of biomarkers such as procalcitonin (PCT). We hereby report an up to 10-fold increase in PCT serum concentrations in four mechanically ventilated patients with ARDS detected within 12-20 hours after iLA implantation in the absence of any infection. Procalcitonin concentrations returned to nearly baseline values in all patients on the fourth day after iLA implantation. We discuss the possible mechanisms of PCT induction in this specific patient population and recommend the onset of antibiotics administration after iLA implantation to be carefully considered in the context of other clinical findings and not solely based on the PCT kinetics. Repeated PCT measurements in short time intervals should be performed in these patients.
authors.affiliation: From the *Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany; and †Department of General Internal Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kott
authors.forename: Burkhard
authors.initials: B
authors.lastname: Bewig
authors.forename: Günther
authors.initials: G
authors.lastname: Zick
authors.forename: Dirk
authors.initials: D
authors.lastname: Schaedler
authors.forename: Tobias
authors.initials: T
authors.lastname: Becher
authors.forename: Inéz
authors.initials: I
authors.lastname: Frerichs
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiler
mesh_terms: D000328:Adult; D000368:Aged; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012121:Respiration, Artificial / Q000295:instrumentation; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012189:Retrospective Studies; D012122:Ventilators, Mechanical / Q000009:adverse effects*
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide