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Critical Care
Published in: Critical Care 5/2006

Open Access 01-10-2006 | Research

Biological markers of lung injury before and after the institution of positive pressure ventilation in patients with acute lung injury

Authors: Magda Cepkova, Sandra Brady, Anil Sapru, Michael A Matthay, Gwynne Church

Published in: Critical Care | Issue 5/2006

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Abstract

Background

Several biological markers of lung injury are predictors of morbidity and mortality in patients with acute lung injury (ALI). The low tidal volume lung-protective ventilation strategy is associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. The primary objective of this study was to test whether the institution of lung-protective positive pressure ventilation in spontaneously ventilating patients with ALI exacerbates pre-existing lung injury by using measurements of biomarkers of lung injury before and after intubation.

Materials and methods

A prospective observational cohort study was conducted in the intensive care unit of a tertiary care university hospital. Twenty-five intubated, mechanically ventilated patients with ALI were enrolled. Physiologic data and serum samples were collected within 6 hours before intubation and at two different time points within the first 24 hours after intubation to measure the concentration of interleukin (IL)-6, IL-8, intercellular adhesion molecule 1 (ICAM-1), and von Willebrand factor (vWF). The differences in biomarker levels before and after intubation were analysed using repeated measures analysis of variance and a paired t test with correction for multiple comparisons.

Results

Before endotracheal intubation, all of the biological markers (IL-8, IL-6, ICAM-1, and vWF) were elevated in the spontaneously breathing patients with ALI. After intubation and the institution of positive pressure ventilation (tidal volume 7 to 8 ml/kg per ideal body weight), none of the biological markers was significantly increased at either an early (3 ± 2 hours) or later (21 ± 5 hours) time point. However, the levels of IL-8 were significantly decreased at the later time point (21 ± 5 hours) after intubation. During the 24-hour period after intubation, the PaO2/FiO2 (partial pressure of arterial oxygen/fraction of the inspired oxygen) ratio significantly increased and the plateau airway pressure significantly decreased.

Conclusion

Levels of IL-8, IL-6, vWF, and ICAM-1 are elevated in spontaneously ventilating patients with ALI prior to endotracheal intubation. The institution of a lung-protective ventilation strategy with positive pressure ventilation does not further increase the levels of biological markers of lung injury. The results suggest that the institution of a lung-protective positive pressure ventilation strategy does not worsen the pre-existing lung injury in most patients with ALI.
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Metadata
Title
Biological markers of lung injury before and after the institution of positive pressure ventilation in patients with acute lung injury
Authors
Magda Cepkova
Sandra Brady
Anil Sapru
Michael A Matthay
Gwynne Church
Publication date
01-10-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5037

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