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Published ahead of print on October 9, 2003, doi:10.1164/rccm.200307-1005OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 1, January 2004, 64-69

A more recent version of this article appeared on January 1, 2004
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Submitted on July 29, 2003
Accepted on October 8, 2003

Exhaled breath condensate detects markers of pulmonary inflammation after cardio-thoracic surgery

Edward D Moloney1, Sharon E Mumby1, Reka Gajdocsi2, Julius H Cranshaw1, Sergei A Kharitonov2, Gregory J Quinlan1, and Mark J Griffiths1*

1 Unit of Critical Care, Imperial College London at the National Heart and Lung Institute, London, United Kingdom, 2 Thoracic Medicine, Imperial College at the National Heart and Lung Institute, London, United Kingdom

* To whom correspondence should be addressed. E-mail: m.griffiths{at}imperial.ac.uk.

Cardiac surgery using cardio-pulmonary by-pass and, to a greater extent lung resection, cause acute lung injury that is usually sub-clinical. 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 broncho-alveolar lavage, in endo-tracheally intubated patients before and after coronary artery bypass graft surgery with cardio-pulmonary bypass and lobectomy. The neutrophil count and leukotriene B4 concentration in broncho-alveolar 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, non-invasive 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, broncho-alveolar lavage, cardio-thoracic surgery, acute lung injury




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