title: Effects of a recruitment maneuver on plasma levels of soluble RAGE in patients with diffuse acute respiratory distress syndrome: a prospective randomized crossover study.
abstract: OBJECTIVE
  The soluble form of the receptor for advanced glycation end-products (sRAGE) is a promising marker for epithelial dysfunction, but it has not been fully characterized as a biomarker of acute respiratory distress syndrome (ARDS). Whether sRAGE could inform on the response to ventilator settings has been poorly investigated, and whether a recruitment maneuver (RM) may influence plasma sRAGE remains unknown.
  
  
  METHODS
  Twenty-four patients with moderate/severe, nonfocal ARDS were enrolled in this prospective monocentric crossover study and randomized into a "RM-SHAM" group when a 6-h-long RM sequence preceded a 6-h-long sham evaluation period, or a "SHAM-RM" group (inverted sequences). Protective ventilation was applied, and RM consisted of the application of 40 cmH2O airway pressure for 40 s. Arterial blood was sampled for gas analyses and sRAGE measurements, 5 min pre-RM (or 40-s-long sham period), 5, 30 min, 1, 4, and 6 h after the RM (or 40-s-long sham period).
  
  
  RESULTS
  Mean PaO2/FiO2, tidal volume, PEEP, and plateau pressure were 125 mmHg, 6.8 ml/kg (ideal body weight), and 13 and 26 cmH2O, respectively. Median baseline plasma sRAGE levels were 3,232 pg/ml. RM induced a significant decrease in sRAGE (-1,598 ± 859 pg/ml) in 1 h (p = 0.043). At 4 and 6 h post-RM, sRAGE levels increased back toward baseline values. Pre-RM sRAGE was associated with RM-induced oxygenation improvement (AUC 0.84).
  
  
  CONCLUSIONS
  We report the first kinetics study of plasma sRAGE after RM in ARDS. Our findings reinforce the value of plasma sRAGE as a biomarker of ARDS.
authors: CHU Clermont-Ferrand, Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing University Hospital, 1 Place Lucie Aubrac, 63003, Clermont-Ferrand Cedex 1, France, mjabaudon@chu-clermontferrand.fr.
authors: Matthieu
authors: M
authors: Jabaudon
authors: Nacim
authors: N
authors: Hamroun
authors: Laurence
authors: L
authors: Roszyk
authors: Renaud
authors: R
authors: Guérin
authors: Jean-Etienne
authors: JE
authors: Bazin
authors: Vincent
authors: V
authors: Sapin
authors: Bruno
authors: B
authors: Pereira
authors: Jean-Michel
authors: JM
authors: Constantin
mesh_terms: D015415:Biomarkers / Q000097:blood; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000067759:Receptor for Advanced Glycation End Products / Q000097:blood*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*
chemical_list: D015415:Biomarkers; D000067759:Receptor for Advanced Glycation End Products