Correlation Between the Levels of NO2 /NO3 in Exhaled Breath Condensate and Pulmonary Infection in Mechanically Ventilated Patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XUE Xiaoyan ,  GAO Zhancheng

Department of Respiratory Medicine, Peking University, People’s Hospital. Beijing, 100044, China;

Corresponding author：

GAO Zhancheng, Email: gaozhancheng5446@163.com

Keywords：

Exhaled breath condensate; Mechanical ventilation; Nitrite/nitrate; Nirtic oxide; Clinical pulmonary infection score

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Objective To explore the correlation between the levels of nitrite / nitrate( NO2 /NO3) in exhaled breath condensate ( EBC) and pulmonary infection in mechanically ventilated patients. Methods The clinical data from ventilated patients in critical care units of Peking University People’s Hospital from November 2006 to August 2007 were collected and analyzed. The patients’clinical pulmonary index score ( CPIS) were calculated. EBC of those patients were collected via endotracheal tube or tracheostomy cannula,and the concentrations of NO2 /NO3 were assayed. The level of NO2 /NO3 in different CPIS patients in 24 hours’ventilation, weaning proportion in 3 days and mortality in different NO2 /NO3 level patients were compared. The correlation of the CPIS and level of NO2 /NO3 were explored between survival and non-survival patients. Results A total of 76 patients were enroled. The NO2 /NO3 levels in patients of CPIS≤3, CPIS 3-6 and CPIS gt;6 in 24 hours of ventilation were ( 23. 31 ±5. 79) , ( 28. 72 ±9. 10) and ( 35. 42 ±12. 10) μmol / L respectively, with significantly differences between each other ( P lt; 0. 01) . The lower the patients’concentration of NO2 /NO3 was, the earlier the weaning and the lower the mortality were. The NO2 /NO3 levels on 4th and 7th day were detected in 24 survival patients and 23 non-survival patients. The difference of NO2 /NO3 levels between the survival patients and non-survival patients became significant on 7th day [ ( 29. 32 ±9. 52) μmol / L vs. ( 37. 22 ±12. 03) μmol / L, P lt; 0. 01] . Linear correlation analysis showed that the NO2 /NO3 level was positively correlated with CPIS ( r = 0. 76, P lt; 0. 01) . Conclusions The NO2 /NO3 level of EBC in ventilated patients is positively correlated to the severity of pulmonary infection, thus may be used as a new predictor for weaning and prognosis.

Citation： XUE Xiaoyan,GAO Zhancheng. Correlation Between the Levels of NO2 /NO3 in Exhaled Breath Condensate and Pulmonary Infection in Mechanically Ventilated Patients. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(4): 333-336. doi: Copy

1.	Horváth I, Hunt J, Barnes PJ, et al. Exhaled breath condensate:methodological recommendations and unresolved questions. Eur Respir J, 2005, 26: 523-548.
2.	陈燕文, 何权瀛, 尚颖, 等. 哮喘患者呼出气冷凝液中硝酸盐/亚硝酸盐、白细胞介素4 和γ干扰素检测的临床意义. 中国呼吸与危重监护杂志.
3.	Tee AK, Hui KP. Effect of spirometric maneuver, nasal clips, and submaximal inspiratory effort on measurement of exhaled nitric oxide levels in asthmatic patients. Chest, 2005 , 127, 131-134 .
4.	Luna CM, Blanzaco D, Niederman MS, et al. resolution of ventilatorassociated pneumonia: prospective evalution of the clinical pulmonary infection score as an early clinical predictor of tcome. Crit Care Med, 2003, 31: 676-682.
5.	American Thoracic Society Workshop. ATS Workshop Proceedings:Exhaled nitric oxide and nitric oxide oxidative metabolism in exhaled breath condensate: executive summary. Am J Respir Crit Care Med, 2006, 173: 811-813.
6.	姜辉, 俞森洋. 临床肺感染评分诊断通气机相关肺炎. 中华医院感染学杂志, 2005, 15: 751-752.
7.	杨国辉, 王广发. 临床肺部感染评分对呼吸机相关肺炎患者预后的评价. 中华结核和呼吸杂志, 2006, 29: 751-754.
8.	叶寰, 刘羽翔. 临床肺部感染评分对无创通气治疗慢性阻塞性肺疾病急性加重期患者呼吸衰竭的疗效预测. 中国呼吸与危重监护杂志, 2007, 11: 424-427.
9.	Kharitonov SA. Exhaled markers of inflammatory lung diseases:ready for routine monitoring? Swiss Med Wkly, 2004, 134: 175-192.
10.	Ganas K, Loukides S, Papatheodorou G, et al. Total nitrite/ nitrate in expired breath condensate of patients with asthma. Respir Med,2001, 95: 649-654.
11.	Kostikas K, Papatheodorou G, Ganas K, et al. pH in expired breath condensate of patients with inflammatory airway diseases. Am J Respir Crit Care Med, 2002, 165: 1364-1370.
12.	Kharitonov SA, Donnelly LE, Montuschi P, et al. Dose-dependent onset and cessation of action of inhaled budesonide on exhaled nitric oxide and symptoms in mild asthma. Thorax, 2002, 57: 889-896.
13.	Liu J, Sandrini A, Thurston M C. Nitric oxide and exhaled breath nitrite /nitrates in chronic obstructive pulmonary disease patients.Respiration, 2007, 74: 617-623.
14.	Corradi M, Pesci A, Casana R, et al. Nitrate in exhaled breath condensate of patients with different airway diseases. Nitric Oxide,2003, 8: 26-30.
15.	Romero PV, Rodríguez B, Martínez S, et al. Analysis of oxidative stress in exhaled breath condensate from patients with severe pulmonary infections. Arch Bronconeumol, 2006, 42: 113-119.
16.	, 8: 131-134.

1. Horváth I, Hunt J, Barnes PJ, et al. Exhaled breath condensate:methodological recommendations and unresolved questions. Eur Respir J, 2005, 26: 523-548.
2. 陈燕文, 何权瀛, 尚颖, 等. 哮喘患者呼出气冷凝液中硝酸盐/亚硝酸盐、白细胞介素4 和γ干扰素检测的临床意义. 中国呼吸与危重监护杂志.
3. Tee AK, Hui KP. Effect of spirometric maneuver, nasal clips, and submaximal inspiratory effort on measurement of exhaled nitric oxide levels in asthmatic patients. Chest, 2005 , 127, 131-134 .
4. Luna CM, Blanzaco D, Niederman MS, et al. resolution of ventilatorassociated pneumonia: prospective evalution of the clinical pulmonary infection score as an early clinical predictor of tcome. Crit Care Med, 2003, 31: 676-682.
5. American Thoracic Society Workshop. ATS Workshop Proceedings:Exhaled nitric oxide and nitric oxide oxidative metabolism in exhaled breath condensate: executive summary. Am J Respir Crit Care Med, 2006, 173: 811-813.
6. 姜辉, 俞森洋. 临床肺感染评分诊断通气机相关肺炎. 中华医院感染学杂志, 2005, 15: 751-752.
7. 杨国辉, 王广发. 临床肺部感染评分对呼吸机相关肺炎患者预后的评价. 中华结核和呼吸杂志, 2006, 29: 751-754.
8. 叶寰, 刘羽翔. 临床肺部感染评分对无创通气治疗慢性阻塞性肺疾病急性加重期患者呼吸衰竭的疗效预测. 中国呼吸与危重监护杂志, 2007, 11: 424-427.
9. Kharitonov SA. Exhaled markers of inflammatory lung diseases:ready for routine monitoring? Swiss Med Wkly, 2004, 134: 175-192.
10. Ganas K, Loukides S, Papatheodorou G, et al. Total nitrite/ nitrate in expired breath condensate of patients with asthma. Respir Med,2001, 95: 649-654.
11. Kostikas K, Papatheodorou G, Ganas K, et al. pH in expired breath condensate of patients with inflammatory airway diseases. Am J Respir Crit Care Med, 2002, 165: 1364-1370.
12. Kharitonov SA, Donnelly LE, Montuschi P, et al. Dose-dependent onset and cessation of action of inhaled budesonide on exhaled nitric oxide and symptoms in mild asthma. Thorax, 2002, 57: 889-896.
13. Liu J, Sandrini A, Thurston M C. Nitric oxide and exhaled breath nitrite /nitrates in chronic obstructive pulmonary disease patients.Respiration, 2007, 74: 617-623.
14. Corradi M, Pesci A, Casana R, et al. Nitrate in exhaled breath condensate of patients with different airway diseases. Nitric Oxide,2003, 8: 26-30.
15. Romero PV, Rodríguez B, Martínez S, et al. Analysis of oxidative stress in exhaled breath condensate from patients with severe pulmonary infections. Arch Bronconeumol, 2006, 42: 113-119.
16. , 8: 131-134.

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