Determining the aetiology of pulmonary oedema by the oedema fluid-to-plasma protein ratio

ABSTRACTIntroductionRecently, fluid collected from the heat-and-moisture-exchange filters, which are commonly used in most mechanically ventilated patients under intravenous sedation, has been reported as a potential surrogate for fluid in the distal airspace. Therefore, collection of this fluid represents a promising, non-invasive method for sampling the distal airspace in patients with acute respiratory distress syndrome (ARDS) and for facilitating a mechanistic understanding of this devastating disease. The current study protocol was constructed to assess whether this fluid could be sampled from a dedicated device (Anaesthetic Conserving Device [AnaConDa-S], Sedana Medical, Danderyd, Sweden) used to deliver inhaled sevoflurane for sedation in patients with ARDS.Methods and analysisA total of 30 adult patients within 24 hours of meeting the Berlin criteria for moderate-severe ARDS and receiving inhaled sevoflurane as standard sedation in participating centres will be eligible for inclusion into this investigator-initiated, exploratory, prospective, bicentre study. After at least 12 h of inhaled sedation, a sample of directly aspirated, undiluted pulmonary oedema fluid will be collected concurrently with fluid from the AnaConDa-S device. Levels of proinflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α and sTNFr-1) and markers of lung endothelial (Ang-2) and epithelial (sRAGE) injury will be measured in both fluids by Multiplex. The primary endpoint is the correlation between protein markers (IL-1β, IL-6, IL-8, TNF-α, sTNFr-1, Ang-2 and sRAGE) measured in the undiluted pulmonary oedema fluid versus the AnaConDa-S fluid.Ethics and disseminationThe study was approved by the appropriate ethics committee (CPP Est I). Informed consent is required. The fluid collection from the AnaConDa-S has potential to foster our understanding of the potential effects of inhaled sedation in clinical ARDS and to open up novel perspectives for prognostic and predictive enrichment in future trials. The results will be published in a peer-reviewed journal.Registration numberNCT03964155.

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Pulmonary microvascular response to hemorrhagic shock, resuscitation, and recovery

Journal of Applied Physiology ◽

10.1152/jappl.1979.46.3.498 ◽

1979 ◽

Vol 46 (3) ◽

pp. 498-503 ◽

Cited By ~ 21

Author(s):

R. H. Demling ◽

G. Niehaus ◽

J. A. Will

Keyword(s):

Hemorrhagic Shock ◽

Plasma Protein ◽

Recovery Period ◽

Blood Gases ◽

Lymph Flow ◽

Base Line ◽

Protein Ratio ◽

Fluid Filtration ◽

Lung Lymph ◽

Protein Permeability

We studied the effect of hemorrhagic shock, resuscitation, and recovery on the pulmonary microcirculation. We used lung lymph flow (QL) and lymph-to-plasma protein ratio as sensitive indices of transvascular fluid filtration rate and protein permeability. We measured pulmonary vascular pressures, cardiac output, blood gases, lymph flow, and lymph and plasma proteins before and during a 2-h period of shock, a 3-h period of resuscitation, and a 72-h period of recovery, in nine unanesthetized sheep with chronic lung lymph fistula. We found a 30% decrease in QL during early shock as animals were bled into bags containing an acetate citrate dextrose solution until aortic pressure was 50 Torr. QL gradually increased to or exceeded base line in five of nine animals during late shock as pulmonary vascula resistance increased by 250%. During the 3-h resuscitation period, mean QL increased by 110%, with the lymph-to-plasma protein ratio being significantly decreased, indicating no protein permeability change. In five of nine studies, lymph became visible bloody. The increased QL and lymph RBCs were felt to be secondary to an elevation in microvascular pressure. During the recovery period, pressures and QL returned to base line.

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The diagnostic separation of transudates and exudates in pleural effusion

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v7i3.6705 ◽

2012 ◽

Vol 7 (3) ◽

pp. 24-28

Author(s):

V Sunanda ◽

K Shravanthi ◽

B Prabhakar Rao ◽

CN Prasad ◽

N Satyanarayana ◽

...

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Plasma Protein ◽

Malignant Pleural Effusion ◽

Medical Sciences ◽

Protein Ratio

The present study was undertaken to compare plasma-pleural effusion albumin gradient with Light’s traditional criteria for differentiating exudates from transudate in pleural effusion who were undergoing diagnostic and therapeutic thoracocentesis in whom the etiology of effusion could be determined were studied. Blood and pleural fluid chemistries were measured to determine plasma-pleural effusion albumin gradient and Light’s criteria parameters like pleural fluid proteins, fluid to plasma protein ratio, fluid LDH and fluid to serum LDH ratio and we observed some misclassifications in exudates and transudates. Using an albumin gradient of 1.2 gm/dl or less to indicate exudate and >1.2 gm/dl to indicate transudate, none of the transudates were found to be is misclassifical, but 1 case of exudate (malignant pleural effusion) was misclassifical. We conclude that although Light’s criteria for exudates are very sensitive, albumin gradient of 1.2 gm/dl or less tends to be more specific to exudates.DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6705 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 24-28

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Sex-steroid-binding plasma protein (SBP), testosterone, oestradiol and dehydroepiandrosterone (DHEA) in prepuberty and puberty

Acta Endocrinologica ◽

10.1530/acta.0.1140060 ◽

1987 ◽

Vol 114 (1) ◽

pp. 60-67 ◽

Cited By ~ 33

Author(s):

Yoshiyuki Maruyama ◽

Norihiko Aoki ◽

Yasuyuki Suzuki ◽

Yasuhiro Ohno ◽

Minoru Imamura ◽

...

Keyword(s):

Plasma Protein ◽

Sharp Increase ◽

Free Testosterone ◽

Sex Steroid ◽

Healthy Individuals ◽

Protein Ratio ◽

Age Related ◽

Hormonal Balance ◽

Steroid Binding ◽

Binding Plasma Protein

Abstract. Measurement of sex-steroid-binding plasma protein in serum of healthy individuals in prepuberty and puberty (74 males and 94 females) was performed using a radioimmunoassay procedure. An age-related decrease of serum SBP was demonstrated during these ages in both sexes. In parallel studies, the serum level of testosterone, oestradiol and dehydroepiandrosterone was evaluated in subjects under 20 years of age. A rise of serum dehydroepiandrosterone levels in both sexes was observed to occur at approximately 8 years of age, being a little bit earlier than the ages for testosterone to rise in males and for oestradiol to rise in females, both of them being at about 10 years of age, respectively. When the testosterone/sex-steroid-binding plasma protein ratio was evaluated as an index of free testosterone concentration in serum, a sharp increase of the ratio was found to occur at 10 years of age and to continue during puberty in both sexes with more marked increment in males than in females. It was suggested that the decrease of SBP in puberty might be largely influenced by alteration in the hormonal balance of testosterone, oestradiol and dehydroepiandrosterone.

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Acid aspiration-induced acute lung injury causes leukocyte-dependent systemic organ injury

Journal of Applied Physiology ◽

10.1152/jappl.1993.74.4.1994 ◽

1993 ◽

Vol 74 (4) ◽

pp. 1994-2003 ◽

Cited By ~ 44

Author(s):

R. C. St John ◽

L. A. Mizer ◽

G. C. Kindt ◽

S. E. Weisbrode ◽

S. A. Moore ◽

...

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Plasma Protein ◽

Cell Activation ◽

Inflammatory Cell ◽

Organ Injury ◽

Protein Ratio ◽

Acid Aspiration ◽

Morphological Alterations ◽

Injury Causes

The adult respiratory distress syndrome is a form of acute lung injury (ALI) that is frequently associated with systemic organ injury and often occurs in the setting of wide-spread inflammatory cell activation. However, whether conditions that lead to ALI result in systemic organ injury is unclear. This study was designed to test the hypothesis that ALI induced by acid aspiration will not result in systemic organ injury. Morphological alterations and lymph-to-plasma protein ratios were measured in autoperfused cat ileum preparations of four control animals and five animals with ALI produced by the endobronchial instillation of 0.1 N HCl (0.5 ml.kg-1.lung-1). After 2 h, the lymph-to-plasma protein ratio (a measure of microvascular permeability) was increased in the ilea of HCl-injured animals compared with control animals (0.234 +/- 0.03 vs. 0.121 +/- 0.005; P = 0.012) and was accompanied by extensive morphological alterations. Four additional HCl-injured animals were pretreated with an antileukocyte adherence antibody (anti-CD18, 2 mg/kg) that blocked the HCl-induced alterations in the ileum. This study provides evidence for significant systemic organ injury after acid aspiration-induced ALI and suggests that the neutrophil may be a key mediator.

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