Effects of a recruitment maneuver on plasma levels of soluble RAGE in patients with diffuse acute respiratory distress syndrome: a prospective randomized crossover study
Effects of a recruitment maneuver on plasma levels of soluble RAGE in patients with diffuse acute respiratory distress syndrome: a prospective randomized crossover study
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DOI：
10.1007/s00134-015-3726-0
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发表时间：
2015-05-01
影响因子：
38.9
通讯作者：
Constantin, Jean-Michel
中科院分区：
文献类型：
--
作者：
Jabaudon, Matthieu;Hamroun, Nacim;Constantin, Jean-Michel
晚期糖基化终末产物受体 (sRAGE) 的可溶形式是上皮功能障碍的一个有前途的标志物，但它尚未被充分表征为急性呼吸窘迫综合征 (ARDS) 的生物标志物。 sRAGE 是否可以告知对呼吸机设置的反应尚未得到充分研究，肺复张操作 (RM) 是否可能影响血浆 sRAGE 仍不清楚。24 名患有中度/重度、非局灶性 ARDS 的患者被纳入这项前瞻性单中心交叉研究，并随机分为“RM-SHAM”组（当 6 小时长的 RM 序列先于 6 小时长的假评估期）或“SHAM-RM”组（反向序列）。采用保护性通气，RM 包括施加 40 cmH(2)O 气道压力 40 秒。在 RM 前 5 分钟（或 40 秒长的假手术期）、RM 后 5、30 分钟、1、4 和 6 小时（或 40 秒长的假手术期）采集动脉血样本进行气体分析和 sRAGE 测量。平均 PaO2/FiO(2)、潮气量、PEEP 和平台压分别为 125 mmHg、6.8 ml/kg（理想身体）重量），分别为 13 和 26 cmH(2)O。中位基线血浆 sRAGE 水平为 3,232 pg/ml。 RM 在 1 小时内诱导 sRAGE 显着降低 (-1,598 +/- A 859 pg/ml) (p = 0.043)。 RM 后 4 小时和 6 小时，sRAGE 水平恢复至基线值。 RM 前的 sRAGE 与 RM 诱导的氧合改善相关（AUC 0.84）。我们报告了 ARDS 中 RM 后血浆 sRAGE 的第一个动力学研究。我们的研究结果强化了血浆 sRAGE 作为 ARDS 生物标志物的价值。
The soluble form of the receptor for advanced glycation end-products (sRAGE) is a promising marker for epithelial dysfunction, but it has not been fully characterized as a biomarker of acute respiratory distress syndrome (ARDS). Whether sRAGE could inform on the response to ventilator settings has been poorly investigated, and whether a recruitment maneuver (RM) may influence plasma sRAGE remains unknown.Twenty-four patients with moderate/severe, nonfocal ARDS were enrolled in this prospective monocentric crossover study and randomized into a "RM-SHAM" group when a 6-h-long RM sequence preceded a 6-h-long sham evaluation period, or a "SHAM-RM" group (inverted sequences). Protective ventilation was applied, and RM consisted of the application of 40 cmH(2)O airway pressure for 40 s. Arterial blood was sampled for gas analyses and sRAGE measurements, 5 min pre-RM (or 40-s-long sham period), 5, 30 min, 1, 4, and 6 h after the RM (or 40-s-long sham period).Mean PaO2/FiO(2), tidal volume, PEEP, and plateau pressure were 125 mmHg, 6.8 ml/kg (ideal body weight), and 13 and 26 cmH(2)O, respectively. Median baseline plasma sRAGE levels were 3,232 pg/ml. RM induced a significant decrease in sRAGE (-1,598 +/- A 859 pg/ml) in 1 h (p = 0.043). At 4 and 6 h post-RM, sRAGE levels increased back toward baseline values. Pre-RM sRAGE was associated with RM-induced oxygenation improvement (AUC 0.84).We report the first kinetics study of plasma sRAGE after RM in ARDS. Our findings reinforce the value of plasma sRAGE as a biomarker of ARDS.