Abstract:
RATIONALE:Standard physiologic assessments of extubation readiness in patients with acute hypoxemic respiratory failure (AHRF) may not reflect lung injury resolution and could adversely affect clinical decision-making and patient outcomes. OBJECTIVES:We hypothesized that elevations in inflammatory plasma biomarkers soluble suppression of tumerogenicity-2 (sST2) and interleukin-6 (IL-6) indicate ongoing lung injury in AHRF and better inform patient outcomes compared to standard clinical assessments. METHODS:We measured daily plasma biomarkers and physiologic variables in 200 patients with AHRF for up to 9 days after intubation. We tested the associations of baseline values with the primary outcome of unassisted breathing at day 29. We analyzed the ability of serial biomarker measurements to inform successful ventilator liberation. MEASUREMENTS AND MAIN RESULTS:Baseline sST2 concentrations were higher in patients dead or mechanically ventilated versus breathing unassisted at day 29 (491.7 ng/mL, IQR 294.5-670.1 ng/mL vs. 314.4 ng/mL, IQR 127.5-550.1 ng/mL, P = 0.0003). Higher sST2 concentrations over time were associated with decreased probability of ventilator liberation (HR 0.80 per log-unit increase, 95% CI 0.75-0.83, P = 0.03). Patients with higher sST2 concentrations on the day of liberation were more likely to fail liberation compared to patients who remained successfully liberated (320.9 ng/mL, IQR 181.1-495.6 ng/mL vs. 161.6 ng/mL, IQR 95.8-292.5 ng/mL, P = 0.002). Elevated sST2 concentrations on the day of liberation decreased the odds of successful liberation when adjusted for standard physiologic parameters (OR 0.325, 95% CI 0.119-0.885, P = 0.03). IL-6 levels did not associate with outcomes. CONCLUSIONS:Using sST2 concentrations to guide ventilator management may more accurately reflect underlying lung injury and outperform traditional measures of readiness for ventilator liberation.
journal_name
Am J Respir Crit Care Medauthors
Alladina J,Levy SD,Cho JL,Brait KL,Rao SR PhD,Camacho A,Hibbert KA,Harris RS,Medoff BD,Januzzi JL,Thompson BT,Bajwa EKdoi
10.1164/rccm.202005-1951OCsubject
Has Abstractpub_date
2021-01-05 00:00:00eissn
1073-449Xissn
1535-4970pub_type
杂志文章abstract::Although impairment of gas exchange caused by ventilation-perfusion (VA/Q) mismatch has been extensively analyzed, there have been no systematic studies focused on determining the distributions of diffusion properties in dose connection with those of VA/Q. We attempted to clarify the simultaneous distributions of VA/Q...
journal_title:American journal of respiratory and critical care medicine
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journal_title:American journal of respiratory and critical care medicine
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