PMID- 36442863
OWN - NLM
STAT- MEDLINE
DCOM- 20230125
LR  - 20230201
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 10
IP  - 1
DP  - 2023 Feb
TI  - New insight: particle flow rate from the airways as an indicator of cardiac 
      failure in the intensive care unit.
PG  - 691-698
LID - 10.1002/ehf2.14242 [doi]
AB  - AIMS: Exhaled breath particles have been explored for diagnosing different lung 
      diseases. We recently showed in an experimental model that different cardiac 
      output results in different particle flow rate (PFR) from the airways. Given the 
      well-known close relationship between impaired cardiac function and respiratory 
      failure, we hypothesized that PFR in exhaled air can be used to detect cardiac 
      failure. METHODS: PFR was analysed using a customized PExA device. Particles in 
      the range of 0.41-4.55 mum were measured. The included patients (n = 20) underwent 
      cardiac surgery and received mechanical ventilation as a part of routine 
      post-operative care. Ten patients with clinical signs of pronounced 
      post-operative haemodynamic instability and need for inotrope or mechanical 
      support had been selected to the cardiac failure group. The control group 
      consisted of 10 patients without signs of cardiac failure. RESULTS: The patients 
      in cardiac failure group required inotropic support in the form of dobutamine 
      (9/10), epinephrine (2/10), or levosimendan (4/10) or use of an intra-aortic 
      balloon pump (4/10). There was no use of inotropes or mechanical support devices 
      among the controls. All patients in the cardiac failure group had pre-operative 
      left ventricular ejection fraction </=40% compared with the control group, whose 
      pre-operative ejection fraction was >/=50%, P < 0.001. Patients with cardiac 
      failure had significantly longer median total time in mechanical ventilation 
      compared with the patients in the control group: 53.5 h (IQR 6.8-116101.0 h) and 
      4.5 h (IQR 4.0-5.5 h), respectively, P < 0.001, and the median length of stay in 
      the ICU, 165 h (IQR 28-192 h) and 22 h (IQR 20-23.5 h), respectively, P = 0.007. 
      Median PFR in patients with cardiac failure was higher than PFR in those with 
      normal cardiac function: 80.9 particles/min (interquartile range (IQR) 25.8-336.6 
      particles/min), vs. 15.3 particles/min (IQR 8.1-17.7 particles/min), 
      respectively, P < 0.001. Median particle mass was 8.95 ng (IQR 1.68-41.73 ng) in 
      the cardiac failure group and 0.75 ng (IQR 0.18-1.45 ng) in the control group, 
      P = 0.002. CONCLUSIONS: Patients with post-operative cardiac failure following 
      cardiac surgery exhibited an increase in exhaled particle mass and PFR compared 
      with the control group, indicating a significant difference between those two 
      groups. The increase in particle mass and PFR in the absence of respiratory 
      pathologies may indicate cardiac failure. In comparison with controls, impaired 
      cardiac function was also associated with different composition of the particles 
      regarding their size distribution.
CI  - (c) 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of European Society of Cardiology.
FAU - Lindstedt, Sandra
AU  - Lindstedt S
AD  - Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden.
AD  - Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.
AD  - Lund Stem Cell Centre, Lund University, Lund, Sweden.
AD  - Department of Clinical Sciences, Lund University, Lund, Sweden.
FAU - Hyllen, Snejana
AU  - Hyllen S
AUID- ORCID: 0000-0003-1253-4969
AD  - Department of Clinical Sciences, Lund University, Lund, Sweden.
AD  - Department of Cardiothoracic Anaesthesia and Intensive Care, Skane University 
      Hospital, Lund, Sweden.
LA  - eng
GR  - Knut and Alice Wallenberg Foundation/
GR  - ALF Foundation/
PT  - Journal Article
DEP - 20221128
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
RN  - 349552KRHK (Simendan)
SB  - IM
MH  - Humans
MH  - Stroke Volume
MH  - *Ventricular Function, Left
MH  - Simendan
MH  - *Heart Failure
MH  - Intensive Care Units
PMC - PMC9871686
OTO - NOTNLM
OT  - Cardiac failure
OT  - Cardiac surgery
OT  - Mechanical ventilation
OT  - Particle flow rate
OT  - Particle mass
COIS- None declared.
EDAT- 2022/11/29 06:00
MHDA- 2023/01/26 06:00
PMCR- 2022/11/28
CRDT- 2022/11/28 20:32
PHST- 2022/10/04 00:00 [revised]
PHST- 2022/04/21 00:00 [received]
PHST- 2022/11/08 00:00 [accepted]
PHST- 2022/11/29 06:00 [pubmed]
PHST- 2023/01/26 06:00 [medline]
PHST- 2022/11/28 20:32 [entrez]
PHST- 2022/11/28 00:00 [pmc-release]
AID - EHF214242 [pii]
AID - 10.1002/ehf2.14242 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2023 Feb;10(1):691-698. doi: 10.1002/ehf2.14242. Epub 2022 Nov 
      28.