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, Ellen Broberg, Jesper Andreasson, Mohammed Fakhro, Anna-Carin Olin, Darcy Wagner, Snejana Hyllén, Sandra Lindstedt

Abstract

Introduction: In this cohort study, we evaluated whether the particles in exhaled air (PExA) device can be used in conjunction with mechanical ventilation during surgery. The PExA device consists of an optical particle counter and an impactor that collects particles in exhaled air. Our aim was to establish the feasibility of the PExA device in combination with mechanical ventilation (MV) during surgery and if collected particles could be analysed. Patients with and without nonsmall cell lung cancer (NSCLC) undergoing lung surgery were compared to normal breathing (NB) patients with NSCLC.

Methods: A total of 32 patients were included, 17 patients with NSCLC (MV-NSCLC), nine patients without NSCLC (MV-C) and six patients with NSCLC and not intubated (NB). The PEx samples were analysed for the most common phospholipids in surfactant using liquid-chromatography-mass-spectrometry (LCMS).

Results: MV-NSCLC and MV-C had significantly lower numbers of particles exhaled per minute (particle flow rate; PFR) compared to NB. MV-NSCLC and MV-C also had a siginificantly lower amount of phospholipids in PEx when compared to NB. MV-NSCLC had a significantly lower amount of surfactant A compared to NB.

Conclusion: We have established the feasibility of the PExA device. Particles could be collected and analysed. We observed lower PFR from MV compared to NB. High PFR during MV may be due to more frequent opening and closing of the airways, known to be harmful to the lung. Online use of the PExA device might be used to monitor and personalise settings for mechanical ventilation to lower the risk of lung damage.

Conflict of interest statement

Conflict of interest: E. Broberg has nothing to disclose. Conflict of interest: J. Andreasson has nothing to disclose. Conflict of interest: M. Fakhro has nothing to disclose. Conflict of interest: A-C. Olin reports that she is a board member and shareholder of PExA AB, and has a patent (wo2009045163) licenced to PExA AB. Conflict of interest: D. Wagner reports a Wallenberg Molecular Medicine Fellowship during the conduct of the study; and speaker's honoraria from Boehringer Ingelheim, an ERC Starting Grant and a Swedish Research Council Starting Grant, outside the submitted work. Conflict of interest: S. Hyllén has nothing to disclose. Conflict of interest: S. Lindstedt reports a Wallenberg Molecular Medicine Fellowship, and grants from the Sjöberg Foundation and the ALF foundation, during the conduct of the study.

Copyright ©ERS 2020.

Figures

FIGURE 1
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
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
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
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
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
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.

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