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Exhaled Breath Condensate Detects Markers of Pulmonary Inflammation after Cardiothoracic Surgery

Unit of Critical Care and Thoracic Medicine, Imperial College London at the National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom

Correspondence and requests for reprints should be addressed to Dr. Mark Griffiths, Ph.D., M.R.C.P., Adult Intensive Care Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. E-mail: m.griffiths{at}imperial.ac.uk

Cardiac surgery using cardiopulmonary by-pass and, to a greater extent, lung resection, causes acute lung injury that is usually subclinical. Analysis of mediators in exhaled breath condensate is a promising means of monitoring inflammation in a variety of airway diseases but the contribution of the airway lining fluid from the lower respiratory tract is uncertain. We compared the analysis of markers of lung injury in exhaled breath condensate and bronchoalveolar lavage in endotracheally intubated patients before and after coronary artery bypass graft surgery with cardiopulmonary bypass and lobectomy. The neutrophil count and leukotriene B₄ concentration in bronchoalveolar lavage fluid rose after coronary artery bypass graft surgery (p < 0.05), but there was no significant change in leukotriene B₄, hydrogen peroxide, or hydrogen ion concentrations in exhaled breath condensate. By contrast, after lobectomy, the concentration in exhaled breath condensate of leukotriene B₄, hydrogen peroxide and hydrogen ions rose significantly (p < 0.05). Exhaled breath condensate is a safe, noninvasive method of sampling the milieu of the distal lung and is sufficiently sensitive to detect markers of inflammation and oxidative stress in patients after lobectomy, but not after the milder insult associated with cardiac surgery.

Key Words: exhaled breath condensate • bronchoalveolar lavage • cardiothoracic surgery • acute lung injury

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