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Mechanically ventilated patients exhibit decreased particle flow in exhaled breath as compared to normal breathing patients

Ellen Broberg, Jesper Andreasson, Mohammed Fakhro, Anna-Carin Olin, Darcy Wagner, Snejana Hyllén, Sandra Lindstedt
ERJ Open Research 2020 6: 00198-2019; DOI: 10.1183/23120541.00198-2019
Ellen Broberg
1Dept of Cardiothoracic Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden
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Jesper Andreasson
2Dept of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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Mohammed Fakhro
2Dept of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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Anna-Carin Olin
3Occupational and Environmental Medicine, Dept of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Darcy Wagner
4Lund University, Experimental Medical Sciences, Lung Bioengineering and Regeneration, Lund, Sweden
5Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
6Lund Stem Cell Center, Lund University, Lund, Sweden
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Snejana Hyllén
1Dept of Cardiothoracic Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden
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Sandra Lindstedt
2Dept of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
5Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
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  • For correspondence: sandra.lindstedt_ingemansson@med.lu.se
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  • FIGURE 1
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    FIGURE 1

    Mechanical ventilation during lung surgery divided into mechanical ventilation in nonsmall cell-lung cancer patients (MV-NSCLC) and mechanical ventilation in control patients (MV-C). The third group is non-intubated, normal breathing (NB) patients.

  • FIGURE 2
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    FIGURE 2

    A timeline of the experiment. Measurements were started when the patients were in the correct position and on one-lung ventilation (OLV). The measurements stopped at the end of surgery when the patients were still on OLV. For nine patients, surgery allowed a period of 5 mins for measurements to be made when changing directly from OLV to double-lung ventilation (DLV) before ending the surgery. PeXA: particles in exhaled air.

  • FIGURE 3
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    FIGURE 3

    The respiratory circuit. The yellow arrow shows the balloon representing the patient and the black arrow, the non-rebreathing valve. The red arrows shows the direction of airflow from the mechanical ventilator to the balloon representing the patient and further on to the particles in exhaled air (PExA) device. The blue arrows show the direction of airflow from the PExA device back to the ventilator.

  • FIGURE 4
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    FIGURE 4

    a) Particle flow rate exhaled per minute in mechanical ventilation in nonsmall cell lung cancer patients (MV-NSCLC), mechanical ventilation in control patients (MV-C) and normal breathing patients (NB). b) Exhaled average particle mass in ng in MV-NSCLC, MV-C and NB. ns: nonsignificant. *: p<0.05; ***: p<0.001.

  • FIGURE 5
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    FIGURE 5

    a) Weight per cent protein (wt. %) of total PEx sample for phospholipids di-palmitoyl-phosphatidyl-choline (DPPC) comparing nonsmall cell lung cancer patients on mechanical ventilation (MV-NSCLC), control patients on mechanical ventilation (MV-C) and non-intubated normal breathing patients (NB). b) wt. % of total PEx sample for palmitoyl-oleoyl-phosphocholine (POPC) comparing MV-NSCLC, MV-C and NB. c) Ratio of DPPC/POPC between MV-NSCLC, MV-C and NB. d) wt. % of total PEx sample for surfactant A (SP-A) comparing MV-NSCLC and NB patients. e) wt. % of total PEx sample for albumin comparing MV-NSCLC and NB. f) The albumin/SP-A ratio between MV-NSCLC and NB. ns: nonsignificant. *: p<0.05; **: p<0.01.

  • FIGURE 6
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    FIGURE 6

    a) Particle flow rate exhaled per minute measured for 5 mins of one-lung ventilation (OLV) before opening up the other lung and followed by measurements for 5 min of double-lung ventilation (DLV). b) Exhaled average particle mass in ng measured for 5 min of OLV followed by measurements for 5 min of DLV. ns: nonsignificant. ***: p<0.001.

Tables

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  • TABLE 1

    Demographics for the three different groups

    MV-NSCLCMV-CNB
    Age years68±260±571±3
    Females9 (50)5 (56)2 (33)
    BMI kg·m−227±1.527±2.427±2.4
    Smoking14 (78)3 (33)4 (67)
    COPD2 (11)02 (33)
    VT L3.42±0.183.86±0.253.20±0.37
    VT %85±584±379±8
    FEV1 L2.45±0.162.15±0.182.18±0.27
    FEV1 %86±574±474±8
    DLCO %84±480±672±5

    Data are presented as mean±sem or n (%). MV-NSCLC: mechanical ventilation in nonsmall cell lung cancer patients; MV-C: mechanical ventilation in control patients; NB: normal breathing patients; BMI: body mass index; VT: tidal volume; FEV1: forced expiratory volume in 1 s; DLCO: diffusing capacity of the lung for carbon monoxide.

    • TABLE 2

      Haemodynamics during mechanical ventilation in nonsmall cell lung cancer (MV-NSCLC) and mechanical ventilation in the control group (MV-C)

      ParametersMV-NSCLCMV-C
      StartStopp-valueStartStopp-value
      BP systolic mmHg106±3104±20.65102±5104±20.87
      BP diastolic mmHg59±257±10.2459±359±20.98
      MAP mmHg76±273±10.2375±376±30.78
      Pulse76±371±40.4178±474±40.41
      EtCO2 kPa5.1±0.14.7±0.10.115.3±0.24.8±0.20.14
      Saturation %99±199±10.1599±199±10.1
      Respiration frequency15±116±10.6116±117±10.84
      VT inspiration mL453±15470±130.43437±27418±270.65
      VT expiration mL440±14453±150.56420±26404±320.72
      Peak pressure cmH2O15±119±10.0115±117±10.32
      Air leakage mL13±221±10.3116±414±70.79

      Data are presented as mean±sem, unless otherwise stated. BP: blood pressure; MAP: mean arterial pressure; EtCO2: end tidal carbon dioxide; VT: tidal volume.

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      Mechanically ventilated patients exhibit decreased particle flow in exhaled breath as compared to normal breathing patients
      Ellen Broberg, Jesper Andreasson, Mohammed Fakhro, Anna-Carin Olin, Darcy Wagner, Snejana Hyllén, Sandra Lindstedt
      ERJ Open Research Jan 2020, 6 (1) 00198-2019; DOI: 10.1183/23120541.00198-2019

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      Mechanically ventilated patients exhibit decreased particle flow in exhaled breath as compared to normal breathing patients
      Ellen Broberg, Jesper Andreasson, Mohammed Fakhro, Anna-Carin Olin, Darcy Wagner, Snejana Hyllén, Sandra Lindstedt
      ERJ Open Research Jan 2020, 6 (1) 00198-2019; DOI: 10.1183/23120541.00198-2019
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