Exhaled NO as a Marker in ARDS and its Prognostic Value
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- Category: Vol. 81, June 2013
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Exhaled NO as a Marker in ARDS and its Prognostic Value,KAMEL ABD ELAZIZ
Abstract
Introduction: Elevated levels of nitric oxide (NO) are detectable in the exhaled breath of patients suffering from a number of inflammatory lung diseases.
Higher urinary NO was associated with improved out-comes in patients with acute lung injury. Measurement of exhaled NO provides an exciting opportunities for the study of critically ill ventilated patients as its inherent non-invasive nature, in turn represents minimal risk to both patient and personnel collecting the sample.
Aim of the Work: To study the level of exhaled NO in patients with acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation and comparing those patients with a control group of ventilated subjects.
Material and Methods: Thirty ARDS patients included in the study collected over a period of nearly two year. On the other hand, the control subjects were studied after induction of anaesthesia and tracheal intubation. NO analyzer currently used in this study is based on a sensitive chemo-luminescence technique.
A full hemodynamic, and lung injury severity score (LISS) were performed, and measurement of exhaled NO was carried out for both group.
Results: Most common cause of ARDS in the study was sepsis (14 patients), patients had pneumonia as a cause of ARDS represented by (8 patients). Mean LISS in the ARDS group was 3.34±0.3; mean exhaled NO concentration was 12.13±3.4ppb in patients with ARDS while it was 5.5±2.7ppb in control subjects. There was significant difference in exhaled NO between the two groups. In the current study, there was no correlation between exhaled NO concentration in ARDS patients and LISS (r=0.25,p 0.4) or Pa02/F102 ratio (r=0.28, p 0.3), and also the pulmonary vascular resistance (PVR) in ARDS group showed no correlation to exhaled NO, (r=0.12 p 0.3). Comparison between survival and non survival subgroup of ARDS showed a significant difference between the two subgroups (p 0.01).
Conclusion: Our study highlight on the level of measured exhaled NO in ARDS patients, aiming for taking it as marker. However, in spite of a significant difference between its level in ARDS patients if compared to control subjects, there was no correlation to LISS. Also there was a significant difference in survival subgroup of ARDS if compared to non survival subgroup that might reflect impression about the relation between the exhaled NO level and the outcome.