Exhaled Breath and Oxygenator Sweep Gas Propionaldehyde in Acute Respiratory Distress Syndrome

Abstract

Background: Oxidative stress-induced lipid peroxidation (LPO) due to neutrophil-derived reactive oxygen species plays a key role in the early stage of the acute respiratory distress syndrome (ARDS). Monitoring of oxidative stress in this patient population is of great interest, and, ideally, this can be done noninvasively. Recently, propionaldehyde, a volatile chemical compound (VOC) released during LPO, was identified in the breath of lung transplant recipients as a marker of oxidative stress. The aim of the present study was to identify if markers of oxidative stress appear in the oxygenator outflow gas of patients with severe ARDS treated with veno-venous extracorporeal membrane oxygenation (ECMO). Methods: The present study included patients with severe ARDS treated with veno-venous ECMO. Concentrations of acetone, isoprene, and propionaldehyde were measured in inspiratory air, exhaled breath, and oxygenator inflow and outflow gas at corresponding time points. Ion-molecule reaction mass spectrometry was used to measure VOCs in a sequential order within the first 24 h and on day three after ECMO initiation. Results: Nine patients (5 female, 4 male; age = 42.1 ± 12.2 year) with ARDS and already established ECMO therapy (pre-ECMO PaO2/FiO2 = 44.0 ± 11.5 mmHg) were included into analysis. VOCs appeared in comparable amounts in breath and oxygenator outflow gas (acetone: 838 (422–7632) vs. 1114 (501–4916) ppbv; isoprene: 53.7 (19.5–244) vs. 48.7 (37.9–108) ppbv; propionaldehyde: 53.7 (32.1–82.2) vs. 42.9 (24.8–122) ppbv). Concentrations of acetone, isoprene, and propionaldehyde in breath and oxygenator outflow gas showed a parallel course with time. Conclusions: Acetone, isoprene, and propionaldehyde appear in breath and oxygenator outflow gas in comparable amounts. This allows for the measurement of these VOCs in a critically ill patient population via the ECMO oxygenator outflow gas without the need of ventilator circuit manipulation.

Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy: A Prospective, Double-Blind, Randomized Controlled Trial

“… 19 , 20 In severe cases, intraoperative oxygen desaturation can threaten the safety of patients. 21 , 22 Therefore, it is of great clinical value to prevent intraoperative hypoxemia during painless gastroscopy in patients with obesity. Our data showed no significant difference in BMI between the two groups, which indicates that the risk of respiratory depression was similar in both groups.…”

Metabolomics profile in acute respiratory distress syndrome by nuclear magnetic resonance spectroscopy in patients with community-acquired pneumonia

“…As a terminal product of fatty acid β-oxidation, increased 3-hydroxybutyrate typically reflects fat utilization as an energy source to compensate for the increased ketone body energetic demands following tissue damage[ 34 ]. Breath acetone is a marker of ischemia–reperfusion-induced oxidative stress, which causes lipid peroxidation and plays a key role in the early stage of ARDS[ 35 ]. A recent study showed that acetoacetate, 3-hydroxybutyric acid, and acetone were markedly elevated in the serum of patients with coronavirus disease[ 36 ].…”

Metabolomics Profile in Acute Respiratory Distress Syndrome By Nuclear Magnetic Resonance Spectroscopy In Patients With Community-Acquired Pneumonia

“…As a terminal product of fatty acid β-oxidation, increased 3-hydroxybutyrate typically re ects fat utilization as an energy source to compensate for the increased ketone body energetic demands following tissue damage [19]. Breath acetone is a marker of ischemia-reperfusion-induced oxidative stress, which causes lipid peroxidation and plays a key role in the early stage of ARDS [33]. A recent study showed that acetoacetate, 3-hydroxybutyric acid, and acetone were markedly elevated in the serum of patients with COVID-19 [34].…”