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Volatile organic compound profiles in outlet air from extracorporeal life-support devices differ from breath profiles in critically ill patients

Jan Hendrik Leopold, Alois Philipp, Thomas Bein, Andreas Redel, Michael Gruber, Marcus J. Schultz, Ameen Abu-Hanna, Paul Brinkman, Hans-Gerd Janssen, Lieuwe D.J. Bos
ERJ Open Research 2019 5: 00134-2018; DOI: 10.1183/23120541.00134-2018
Jan Hendrik Leopold
1Dept of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Alois Philipp
2Dept of Intensive Care, University Hospital Regensburg, Regensburg, Germany
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Thomas Bein
2Dept of Intensive Care, University Hospital Regensburg, Regensburg, Germany
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Andreas Redel
2Dept of Intensive Care, University Hospital Regensburg, Regensburg, Germany
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Michael Gruber
2Dept of Intensive Care, University Hospital Regensburg, Regensburg, Germany
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Marcus J. Schultz
1Dept of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
3Dept of Intensive Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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Ameen Abu-Hanna
1Dept of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Paul Brinkman
1Dept of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Hans-Gerd Janssen
4Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
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Lieuwe D.J. Bos
1Dept of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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  • ORCID record for Lieuwe D.J. Bos
  • For correspondence: l.d.bos@amc.uva.nl
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  • FIGURE 1
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    FIGURE 1

    Correlation plots for eNose sensor values: breath sensor values plotted against extracorporeal membrane oxygenation sensor values for a) sensor 1, b) sensor 2, c) sensor 3 and d) sensor 4. Each colour represents a different patient. The black line represents the correlation between the two measurement sites.

  • FIGURE 2
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    FIGURE 2

    Correlation between the concentration of volatile organic compounds (VOCs) in exhaled breath and in air coming from the extracorporeal circulation. The y-axis shows the retention time of the VOCs. The y-axis shows the correlation coefficient between the concentration of VOCs in breath and in air coming from the extracorporeal circulation. 1: acetone; 2: isoprene; 3: 2-propanol, 1,1,1,3,3,3-hexafluoro-; 4: 1-propanol; 5: pentane, 3-methyl-; 6: pentane, 2,4-dimethyl-; 7: furan, 2-methyl; 8: ethyl acetate; 9: 2,4-hexadiyne; 10: 1-pentene, 2,4,4-trimethyl-; 11: unknown; 12: unknown; 13: unknown; 14: unknown; 15: benzene, chloro-; 16: 3-hexanone, 2-methyl-; 17: 2-propanol, 1,1,1-trichloro-2-methyl-; 18: unknown; 19: pentane, 2,2,3-trimethyl-; 20: unknown; 21: d-limonene; 22: unknown; 23: undecane; 24: unknown; 25: unknown; 26: unknown; 27: unknown; 28: unknown; 29: propofol.

  • FIGURE 3
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    FIGURE 3

    Fold change between exhaled breath concentration and extracorporeal air concentration, and the correlation coefficient between the two measurement sites. ECMO: extracorporeal membrane oxygenation; VOC: volatile organic compound. The x-axis shows the correlation coefficient between VOCs in breath and in air coming from the extracorporeal circulation. The y-axis shows the fold change in VOC abundance between the two measurement sites.

Tables

  • Figures
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  • TABLE 1

    Patient characteristics

    Patients10
    Age years56 (51–65)
    Male4 (40)
    Caucasian10 (100)
    Diagnosis
     ARDS6 (60)
     Hypercapnia2 (20)
     Cardiogenic shock1 (10)
     Pulmonary embolism1 (10)
    Type of extracorporeal circulation
     ECMO8 (80)
      Oxygen flow rate L·min−162.4±1.3
     ECCO2R2 (20)
      Oxygen flow rate L·min−15.2±1.3
    Respiratory variables
     Minute ventilation L·min−18.0±2.9
     Tidal volume mL412±158
     PEEP cmH2O11±4.5
    ICU LOS days36 (35–57)
    Duration of eNose monitoring h73 (72–113)

    Data are presented as median (interquartile range), n (%) or mean±sd. ARDS: acute respiratory distress syndrome; ECMO: extracorporeal membrane oxygenation; ECCO2R: extracorporeal carbon dioxide removal; PEEP: positive end-expiratory pressure; ICU: intensive care unit; LOS: length of stay.

    • TABLE 2

      Additional pressure in front of the membrane when the eNose is connected to the membrane gas outlet

      Membrane#In-membrane pressure mmHgAdditional pressure cmH2O
      Maquet60−0.56 (−2.00–0.33)
      120−0.18 (−3.00–1.33)
      1500.07 (−1.33–1.00)
      Medos60−0.04 (−0.67–0.33)
      120−0.02 (−1.00–0.67)
      1500.04 (−0.33–0.33)
      Novalung60−0.11 (−1.33–0.00)
      120−0.31 (−1.33–0.00)
      150−0.04 (−0.67–0.33)
      Sorin60−0.04 (−0.67–0.00)
      120−0.16 (−1.00–0.33)
      1500.00 (0.00–0.00)

      Data for additional pressure are presented as mean (range). #: see main text for details of membranes.

      • TABLE 3

        Volatile organic compounds showing a significant correlation (r) between the external outlet of the membrane and the outlet of the tube of the ventilator

        Retention time minrp-valueProportion breath/ECMOIdentityPresumed source
        2.320.560.00180.61AcetoneEndogenous
        2.470.370.04720.55IsopreneEndogenous
        2.780.840.00000.992-Propanol, 1,1,1,3,3,3-hexafluoro-Anaesthetic
        3.220.380.03951.261-PropanolExogenous
        3.500.450.01390.4Pentane, 3-methyl-Endogenous?
        3.800.410.02551Pentane, 2,4-dimethyl-Endogenous?
        4.200.480.00900.80Furan, 2-methylExogenous
        4.220.530.00290.54Ethyl acetateEndogenous
        5.780.430.01970.992,4-HexadiyneExogenous
        7.330.890.000011-Pentene, 2,4,4-trimethyl-Exogenous
        8.850.820.00001.18Unknown
        9.720.380.04311.27Unknown
        9.830.790.00001.19Unknown
        11.400.620.00040.89Unknown
        11.470.670.00010.83Benzene, chloro-Exogenous
        11.950.680.00000.413-Hexanone, 2-methyl-Endogenous?
        14.470.560.00150.832-Propanol, 1,1,1-trichloro-2-methyl-Exogenous
        14.470.700.00000.99Unknown
        14.880.410.02860.62Pentane, 2,2,3-trimethyl-
        15.23−0.440.01616.35Unknown
        15.550.730.00001.22d-LimoneneExogenous
        17.070.600.00060.90Unknown
        18.550.670.00010.66UndecaneEndogenous?
        19.030.620.00030.84Unknown
        19.530.760.00000.82Unknown
        20.650.860.00000.77Unknown
        21.100.750.00000.88Unknown
        21.220.600.00050.94Unknown
        21.320.400.02990.18PropofolAnaesthetic

        ECMO: extracorporeal membrane oxygenation.

        Supplementary Materials

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          Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

          Supplementary material 00134-2018.supp

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        Volatile organic compound profiles in outlet air from extracorporeal life-support devices differ from breath profiles in critically ill patients
        Jan Hendrik Leopold, Alois Philipp, Thomas Bein, Andreas Redel, Michael Gruber, Marcus J. Schultz, Ameen Abu-Hanna, Paul Brinkman, Hans-Gerd Janssen, Lieuwe D.J. Bos
        ERJ Open Research Apr 2019, 5 (2) 00134-2018; DOI: 10.1183/23120541.00134-2018

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        Volatile organic compound profiles in outlet air from extracorporeal life-support devices differ from breath profiles in critically ill patients
        Jan Hendrik Leopold, Alois Philipp, Thomas Bein, Andreas Redel, Michael Gruber, Marcus J. Schultz, Ameen Abu-Hanna, Paul Brinkman, Hans-Gerd Janssen, Lieuwe D.J. Bos
        ERJ Open Research Apr 2019, 5 (2) 00134-2018; DOI: 10.1183/23120541.00134-2018
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