Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study

Andreas Kofoed*, Mathias Hindborg, Jeppe Hjembæk-Brandt, Christian Dalby Sørensen, Mette Kolpen, Morten H. Bestle

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstract

It can be a clinical challenge to distinguish inflammation from infection in critically ill patients. Therefore, valid and conclusive surrogate markers for infections are desired. Nitric oxide (NO) might be that marker since concentrations of exhaled NO have shown to change in the presence of various diseases. This observational, prospective, single-center feasibility study aimed to investigate if fractional exhaled NO (FeNO) can be measured in intubated patients with or without infection, pneumonia and septic shock in a standardized, reliable setting. 20 intubated patients in the intensive care unit (ICU) were included for analysis. FeNO mean values were measured in the endotracheal tube via the suction channel using a chemiluminescence based analyzer. We developed a pragmatic method to measure FeNO repeatedly and reliably in intubated patients using a chemiluminescence based analyzer. We found a median of 0.98 (0.59-1.44) FeNO mean (ppb) in exhaled breath from all 20 intubated patient. Intubated patient with suspected infection had a significantly lower median FeNO mean compared with the intubated patients without suspected infection. Similarly did patients with septic shock demonstrate a significantly lower median FeNO mean than without septic shock. We found no statistical difference in median FeNO mean for intubated patients with pneumonia. It was feasible to measure FeNO in intubated patients in the ICU. Our results indicate decreased levels of FeNO in infected intubated patients in the ICU. The study was not powered to provide firm conclusions, so larger trials are needed to confirm the results and to prove FeNO as a useful biomarker for distinguishment between infection and inflammation in the ICU.

OriginalsprogEngelsk
Artikelnummer046014
TidsskriftJournal of Breath Research
Vol/bind17
Udgave nummer4
Antal sider6
ISSN1752-7155
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
We thank research nurses Sanne Lauritzen and Lone Valbjørn (Department of Anaesthesia and Intensive Care, Copenhagen University Hospital—North Zealand, Hilleroed, Denmark) for assistance with sample collection, and obtaining informed consent from patient proxies and patients.

Publisher Copyright:
© 2023 IOP Publishing Ltd.

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