Monitoring of oxidative and metabolic stress during cardiac surgery by means of breath biomarkers: an observational study

Abstract

Background: Volatile breath biomarkers provide a non-invasive window to observe physiological and pathological processes in the body. This study was intended to assess the impact of heart surgery with extracorporeal circulation (ECC) onto breath biomarker profiles. Special attention was attributed to oxidative or metabolic stress during surgery and extracorporeal circulation, which can cause organ damage and poor outcome.

Methods: 24 patients undergoing cardiac surgery with extracorporeal circulation were enrolled into this observational study. Alveolar breath samples (10 mL) were taken after induction of anesthesia, after sternotomy, 5 min after end of ECC, and 30, 60, 90, 120 and 150 min after end of surgery. Alveolar gas samples were withdrawn from the circuit under visual control of expired CO2. Inspiratory samples were taken near the ventilator inlet. Volatile substances in breath were preconcentrated by means of solid phase micro extraction, separated by gas chromatography, detected and identified by mass spectrometry.

Results: Mean exhaled concentrations of acetone, pentane and isoprene determined in this study were in accordance with results from the literature. Exhaled substance concentrations showed considerable inter-individual variation, and inspired pentane concentrations sometimes had the same order of magnitude than expired values. This is the reason why, concentrations were normalized by the values measured 120 min after surgery. Exhaled acetone concentrations increased slightly after sternotomy and markedly after end of ECC. Exhaled acetone concentrations exhibited positive correlation to serum C-reactive protein concentrations and to serum troponine-T concentrations. Exhaled pentane concentrations increased markedly after sternotomy and dropped below initial values after ECC. Breath pentane concentrations showed correlations with serum creatinine (CK) levels. Patients with an elevated CK-MB (myocardial&brain)/CK ratio had also high concentrations of pentane in exhaled air. Exhaled isoprene concentrations raised significantly after sternotomy and decreased to initial levels at 30 min after end of ECC. Exhaled isoprene concentrations showed a correlation with cardiac output.

Conclusion: Oxidative and metabolic stress during cardiac surgery could be assessed continuously and non-invasively by means of breath analysis. Correlations between breath acetone profiles and clinical conditions underline the potential of breath biomarker monitoring for diagnostics and timely initiation of life saving therapy.

Figures

Figure 1

Exhaled acetone concentrations before, during and after surgery. T1 – t8 indicate time of breath gas testing in the patients. t1 after induction of anaesthesia, t2 after sternotomy, t3 5 min after end of extracorporeal circulation, t4 30 min, t5 60 min, t6 90 min and t8 150 min after end of surgery. Exhaled substance concentrations were normalized to respective concentrations at t7 120 min after end of surgery (Ci/C120). N number of patients in which exhaled acetone was determined. #, § * indicate significant differences between median values.

Figure 2

Exhaled pentane concentrations before, during and after surgery. T1 – t8 indicate time of breath gas testing in the patients. t1 after induction of anaesthesia, t2 after sternotomy, t3 5 min after end of extracorporeal circulation, t4 30 min, t5 60 min, t6 90 min and t8 150 min after end of surgery. Exhaled substance concentrations were normalized to respective concentrations at t7 120 min after end of surgery (Ci/C120). N numbers of patients in which exhaled pentane was determined. #, § * indicate significant differences between median values.

Figure 3

Exhaled isoprene concentrations before, during and after surgery. T1 – t8 indicate time of breath gas testing in the patients. t1 after induction of anaesthesia, t2 after sternotomy, t3 5 min after end of extracorporeal circulation, t4 30 min, t5 60 min, t6 90 min and t8 150 min after end of surgery. Exhaled substance concentrations were normalized to respective concentrations at t7 120 min after end of surgery (Ci/C120). N numbers of patients in which exhaled isoprene was determined. #, § indicate significant differences between median values.