title: Oxidative lung injury correlates with one-lung ventilation time during pulmonary lobectomy: a study of exhaled breath condensate and blood.
abstract: OBJECTIVE
  During lung lobectomy, the operated lung is collapsed and hypoperfused; oxygen deprivation is accompanied by reactive hypoxic pulmonary vasoconstriction. After lung lobectomy, ischaemia present in the collapsed state is followed by expansion-reperfusion and lung injury attributed to the production of reactive oxygen species. The primary objective of this study was to investigate the time course of several markers of oxidative stress simultaneously in exhaled breath condensate and blood and to determine the relationship between oxidative stress and one-lung ventilation time in patients undergoing lung lobectomy.
  
  
  METHODS
  This single-centre, observational, prospective study included 28 patients with non-small-cell lung cancer who underwent lung lobectomy. We measured the levels of hydrogen peroxide, 8-iso-PGF2α, nitrites plus nitrates and pH in exhaled breath condensate (n = 25). The levels of 8-iso-PGF2α and nitrites plus nitrates were also measured in blood (n = 28). Blood samples and exhaled breath condensate samples were collected from all patients at five time points: preoperatively; during one-lung ventilation, immediately before resuming two-lung ventilation; immediately after resuming two-lung ventilation; 60 min after resuming two-lung ventilation and 180 min after resuming two-lung ventilation.
  
  
  RESULTS
  Both exhaled breath condensate and blood exhibited significant and simultaneous increases in oxidative-stress markers immediately before two-lung ventilation was resumed. However, all these values underwent larger increases immediately after resuming two-lung ventilation. In both exhaled breath condensate and blood, marker levels significantly and directly correlated with the duration of one-lung ventilation immediately before resuming two-lung ventilation and immediately after resuming two-lung ventilation. Although pH significantly decreased in exhaled breath condensate immediately after resuming two-lung ventilation, these pH values were inversely correlated with the duration of one-lung ventilation.
  
  
  CONCLUSIONS
  During lung lobectomy, the operated lung is collapsed and oxidative injury occurs, with the levels of markers of oxidative stress increasing simultaneously in exhaled breath condensate and blood during one-lung ventilation. These increases were larger after resuming two-lung ventilation. Increases immediately before resuming two-lung ventilation and immediately after resuming two-lung ventilation were directly correlated with the duration of one-lung ventilation.
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valencia, Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain josegarciadelaasuncion@gmail.com.
authors.forename: José
authors.initials: J
authors.lastname: García-de-la-Asunción
authors.affiliation: Department of Thoracic Surgery, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: García-del-Olmo
authors.affiliation: Laboratory of Biochemistry, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Perez-Griera
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valencia, Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Martí
authors.affiliation: Department of Thoracic Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Genaro
authors.initials: G
authors.lastname: Galan
authors.affiliation: Department of Thoracic Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Morcillo
authors.affiliation: Department of Thoracic Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Richard
authors.initials: R
authors.lastname: Wins
authors.affiliation: Department of Thoracic Surgery, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Guijarro
authors.affiliation: Department of Thoracic Surgery, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arnau
authors.affiliation: Department of Pharmacology, University of Valencia, Valencia, Spain.
authors.forename: Benjamín
authors.initials: B
authors.lastname: Sarriá
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valencia, Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: García-Raimundo
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valencia, Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Belda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests / Q000379:methods; D015237:Dinoprost / Q000031:analogs & derivatives / Q000032:analysis; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000032:analysis; D009573:Nitrites / Q000032:analysis; D061810:One-Lung Ventilation / Q000009:adverse effects*; D018384:Oxidative Stress; D011013:Pneumonectomy / Q000009:adverse effects*; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000209:etiology*; D055397:Ventilator-Induced Lung Injury / Q000209:etiology*
chemical_list: D015415:Biomarkers; D009566:Nitrates; D009573:Nitrites; C075750:8-epi-prostaglandin F2alpha; D015237:Dinoprost; D006861:Hydrogen Peroxide
keywords: 8-Isoprostane; Exhaled breath condensate; Hydrogen peroxide; Nitrites and nitrates; One-lung ventilation; Oxidative lung injury