Monitoring lung injury with particle flow rate in LPS‐ and COVID‐19‐induced ARDS. Issue 13 (11th July 2021)

• Record Type: Journal Article
• Authors: Stenlo, Martin; Silva, Iran A. N.; Hyllén, Snejana; Bölükbas, Deniz A.; Niroomand, Anna; Grins, Edgars; Ederoth, Per; Hallgren, Oskar; Pierre, Leif; Wagner, Darcy E.; Lindstedt, Sandra
• Is Part Of: Physiological reports. Volume 9:Issue 13(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-07-11
• Subjects: acute respiratory distress syndrome -- COVID‐19 -- extra corporal membrane oxygenation -- lung injury diagnostics; Physiology -- Periodicals; 571
• DOI: 10.14814/phy2.14802
• Languages: English
• ISSNs: 2051-817X

Abstract

Abstract: In severe acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) is a life‐prolonging treatment, especially among COVID‐19 patients. Evaluation of lung injury progression is challenging with current techniques. Diagnostic imaging or invasive diagnostics are risky given the difficulties of intra‐hospital transportation, contraindication of biopsies, and the potential for the spread of infections, such as in COVID‐19 patients. We have recently shown that particle flow rate (PFR) from exhaled breath could be a noninvasive, early detection method for ARDS during mechanical ventilation. We hypothesized that PFR could also measure the progress of lung injury during ECMO treatment. Lipopolysaccharide (LPS) was thus used to induce ARDS in pigs under mechanical ventilation. Eight were connected to ECMO, whereas seven animals were not. In addition, six animals received sham treatment with saline. Four human patients with ECMO and ARDS were also monitored. In the pigs, as lung injury ensued, the PFR dramatically increased and a particular spike followed the establishment of ECMO in the LPS‐treated animals. PFR remained elevated in all animals with no signs of lung recovery. In the human patients, in the two that recovered, PFR decreased. In the two whose lung function deteriorated while on ECMO, there was increased PFR with no sign of recovery in lung function. The present results indicate that real‐time monitoring of PFR may be a new, complementary approach in the clinic for measurement of the extent of lung injury and recovery over time in ECMO patients with ARDS. Abstract : Particle flow rate (PFR) used in conjunction with mechanical ventilation can be used to monitor lung injury during ECMO treatment in animals with LPS induced ARDS and in humans with COVID‐19 induced ARDS. The present results indicate that real‐time monitoring of PFR may be a new, complementary approach in the clinic for measurement of the extent of lung injury and recovery over time in ECMO patients with ARDS.