The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

COLLECTION OF EXHALED BREATH CONDENSATE IN MECHANICALLY VENTILATED PEDIATRIC PATIENTS

Emily B. Martin1,2, Amy L. Robinson2, Roby Greenwald3, Rigby R. Mark1,2, Atul Vats1,2; 1Pediatric Critical Care, Emory University, Atlanta, GA; 2Children’s Healthcare of Atlanta, Atlanta, GA; 3Emory University School of Public Health, Atlanta, GA

Background: Collection and analysis of exhaled breath condensate (EBC) has become a rapidly growing area of study. Studies of EBC suggest that changes in pH, nitric oxide, and leukotriene levels correlate with airway inflammation. Studies in mechanically ventilated adult patients have demonstrated that EBC collection from the ventilator circuit is safe and produces samples adequate for analysis, although methods of collection vary. Collection of EBC from the ventilator circuit has been previously been described, but these methods often have limited analysis capability. Data using these techniques in pediatric patients is also limited. Method: We describe a method for collection of EBC from patients in a pediatric intensive care unit being mechanically ventilated using the Servo-i ventilator (Siemens) and RT236/RT240 Evaqua ventilator circuits (Fisher & Paykel). We use the RTube EBC collection device (RTube; Respiratory Research, Inc.) attached to the exhalation limb of the circuit at the wye connector. The mouthpiece is easily removed from the RTube, which was then adapted to the circuit using elbow connectors included with the RT240. The RTube’s aluminum sleeve allows for collection at -4 to -20 C. Collection was performed for 20-40 minutes (depending on the patient’s minute ventilation), resulting in 1-2 mL of EBC. Samples were frozen to -15 C after collection and then stored at -80 C prior to undergoing laboratory evaluation for pH, nitric oxide reaction products, cytokines, leukotrienes, ions (sodium, chloride, potassium). Results: EBC was collected successfully from 8 patients ages 7 months to 16 years. One additional collection from a 7 month old infant had to be stopped early due to patient agitation and desaturations, which was not felt to be related to the EBC collection. The other 8 patients tolerated collection well with no significant changes in cardiorespiratory status or end tidal CO2 measurements. Early data analysis from the 8 samples, compared to that obtained from spontaneously breathing patients, has shown similar levels of nitric oxide products, ions, and formic acid, but lower levels of ammonia. Conclusion: Collection of EBC from mechanically ventilated pediatric patients is safe and produces samples adequate for analysis by adapting the R tube collection device to the exhalation limb of the RT236 Evaqua ventilator circuit. Collection with the RTube allows for both storage and more extensive analysis of the collected EBC. Sponsored Research - None

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