Jehan Alladina1, Sean D Levy2, Josalyn L Cho3, Kelsey L Brait1, Sowmya R Rao4, Alexander Camacho5, Kathryn A Hibbert1, R Scott Harris1,6, Benjamin D Medoff1, James L Januzzi5, B Taylor Thompson1, Ednan K Bajwa1. 1. Division of Pulmonary and Critical Care Medicine and. 2. Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 3. Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. 4. Boston University School of Public Health, Boston, Massachusetts; and. 5. Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts. 6. Vertex Pharmaceuticals, Boston, Massachusetts.
Abstract
Rationale: Standard physiologic assessments of extubation readiness in patients with acute hypoxemic respiratory failure (AHRF) may not reflect lung injury resolution and could adversely affect clinical decision-making and patient outcomes. Objectives: We hypothesized that elevations in inflammatory plasma biomarkers sST2 (soluble suppression of tumorigenicity-2) and IL-6 indicate ongoing lung injury in AHRF and better inform patient outcomes compared with standard clinical assessments. Methods: We measured daily plasma biomarkers and physiologic variables in 200 patients with AHRF for up to 9 days after intubation. We tested the associations of baseline values with the primary outcome of unassisted breathing at Day 29. We analyzed the ability of serial biomarker measurements to inform successful ventilator liberation. Measurements and Main Results: Baseline sST2 concentrations were higher in patients dead or mechanically ventilated versus breathing unassisted at Day 29 (491.7 ng/ml [interquartile range (IQR), 294.5-670.1 ng/ml] vs. 314.4 ng/ml [IQR, 127.5-550.1 ng/ml]; P = 0.0003). Higher sST2 concentrations over time were associated with a decreased probability of ventilator liberation (hazard ratio, 0.80 per log-unit increase; 95% confidence interval [CI], 0.75-0.83; P = 0.03). Patients with higher sST2 concentrations on the day of liberation were more likely to fail liberation compared with patients who remained successfully liberated (320.9 ng/ml [IQR, 181.1- 495.6 ng/ml] vs. 161.6 ng/ml [IQR, 95.8-292.5 ng/ml]; P = 0.002). Elevated sST2 concentrations on the day of liberation decreased the odds of successful liberation when adjusted for standard physiologic parameters (odds ratio, 0.325; 95% CI, 0.119-0.885; P = 0.03). IL-6 concentrations did not associate with outcomes. Conclusions: Using sST2 concentrations to guide ventilator management may more accurately reflect underlying lung injury and outperform traditional measures of readiness for ventilator liberation.
Rationale: Standard physiologic assessments of extubation readiness in patients with acute hypoxemic respiratory failure (AHRF) may not reflect lung injury resolution and could adversely affect clinical decision-making and patient outcomes. Objectives: We hypothesized that elevations in inflammatory plasma biomarkers sST2 (soluble suppression of tumorigenicity-2) and IL-6 indicate ongoing lung injury in AHRF and better inform patient outcomes compared with standard clinical assessments. Methods: We measured daily plasma biomarkers and physiologic variables in 200 patients with AHRF for up to 9 days after intubation. We tested the associations of baseline values with the primary outcome of unassisted breathing at Day 29. We analyzed the ability of serial biomarker measurements to inform successful ventilator liberation. Measurements and Main Results: Baseline sST2 concentrations were higher in patients dead or mechanically ventilated versus breathing unassisted at Day 29 (491.7 ng/ml [interquartile range (IQR), 294.5-670.1 ng/ml] vs. 314.4 ng/ml [IQR, 127.5-550.1 ng/ml]; P = 0.0003). Higher sST2 concentrations over time were associated with a decreased probability of ventilator liberation (hazard ratio, 0.80 per log-unit increase; 95% confidence interval [CI], 0.75-0.83; P = 0.03). Patients with higher sST2 concentrations on the day of liberation were more likely to fail liberation compared with patients who remained successfully liberated (320.9 ng/ml [IQR, 181.1- 495.6 ng/ml] vs. 161.6 ng/ml [IQR, 95.8-292.5 ng/ml]; P = 0.002). Elevated sST2 concentrations on the day of liberation decreased the odds of successful liberation when adjusted for standard physiologic parameters (odds ratio, 0.325; 95% CI, 0.119-0.885; P = 0.03). IL-6 concentrations did not associate with outcomes. Conclusions: Using sST2 concentrations to guide ventilator management may more accurately reflect underlying lung injury and outperform traditional measures of readiness for ventilator liberation.
Authors: Ozlem U Gurkan; Chaoxia He; Rachel Zielinski; Hamid Rabb; Landon S King; Jeffrey M Dodd-o; Franco R D'Alessio; Neil Aggarwal; David Pearse; Patrice M Becker Journal: Exp Lung Res Date: 2011-11-01 Impact factor: 2.459
Authors: A Esteban; F Frutos; M J Tobin; I Alía; J F Solsona; I Valverdú; R Fernández; M A de la Cal; S Benito; R Tomás Journal: N Engl J Med Date: 1995-02-09 Impact factor: 91.245
Authors: Jehan W Alladina; Sean D Levy; Kathryn A Hibbert; James L Januzzi; R Scott Harris; Michael A Matthay; B Taylor Thompson; Ednan K Bajwa Journal: Crit Care Med Date: 2016-09 Impact factor: 7.598
Authors: Jehan W Alladina; Francesca L Giacona; Emma B White; Kelsey L Brait; Elizabeth A Abe; Sam A Michelhaugh; Kathryn A Hibbert; James L Januzzi; B Taylor Thompson; Josalyn L Cho; Benjamin D Medoff Journal: Crit Care Explor Date: 2021-06-29
Authors: Georgios D Kitsios; Daniel Kotok; Haopu Yang; Malcolm A Finkelman; Yonglong Zhang; Noel Britton; Xiaoyun Li; Marina S Levochkina; Amy K Wagner; Caitlin Schaefer; John J Villandre; Rui Guo; John W Evankovich; William Bain; Faraaz Shah; Yingze Zhang; Barbara A Methé; Panayiotis V Benos; Bryan J McVerry; Alison Morris Journal: JCI Insight Date: 2021-07-22