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BMC Pulm Med

Title:		Volatile organic compounds in ventilated critical care patients: a systematic evaluation of cofactors
Author(s):		Huppe T; Lorenz D; Wachowiak M; Maurer F; Meiser A; Groesdonk H; Fink T; Sessler DI; Kreuer S;
Address:		"Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany. tobias.hueppe@uks.eu. Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany. Department of Anaesthesiology and Intensive Care, Klinikum Lunen St.-Marien-Hospital, Lunen, Germany. Department of Outcomes Research, Anesthesiology Institute, ASCleveland Clinic, Cleveland, OH, USA"
Journal Title:		BMC Pulm Med
Year:		2017
Volume:		20170822
Issue:		1
Page Number:		116 -
DOI:		10.1186/s12890-017-0460-0
ISSN/ISBN:		1471-2466 (Electronic) 1471-2466 (Linking)
Abstract:		"BACKGROUND: Expired gas (exhalome) analysis of ventilated critical ill patients can be used for drug monitoring and biomarker diagnostics. However, it remains unclear to what extent volatile organic compounds are present in gases from intensive care ventilators, gas cylinders, central hospital gas supplies, and ambient air. We therefore systematically evaluated background volatiles in inspired gas and their influence on the exhalome. METHODS: We used multi-capillary column ion-mobility spectrometry (MCC-IMS) breath analysis in five mechanically ventilated critical care patients, each over a period of 12 h. We also evaluated volatile organic compounds in inspired gas provided by intensive care ventilators, in compressed air and oxygen from the central gas supply and cylinders, and in the ambient air of an intensive care unit. Volatiles detectable in both inspired and exhaled gas with patient-to-inspired gas ratios < 5 were defined as contaminating compounds. RESULTS: A total of 76 unique MCC-IMS signals were detected, with 39 being identified volatile compounds: 73 signals were from the exhalome, 12 were identified in inspired gas from critical care ventilators, and 34 were from ambient air. Five volatile compounds were identified from the central gas supply, four from compressed air, and 17 from compressed oxygen. We observed seven contaminating volatiles with patient-to-inspired gas ratios < 5, thus representing exogenous signals of sufficient magnitude that might potentially be mistaken for exhaled biomarkers. CONCLUSIONS: Volatile organic compounds can be present in gas from central hospital supplies, compressed gas tanks, and ventilators. Accurate assessment of the exhalome in critical care patients thus requires frequent profiling of inspired gases and appropriate normalisation of the expired signals"
Keywords:		"Aged Biomarkers *Breath Tests *Exhalation Humans Intensive Care Units Middle Aged *Respiration, Artificial Respiratory Tract Diseases/diagnosis Volatile Organic Compounds/*analysis/chemistry Anaesthesia Breath analysis Critical care Mechanical ventilation;"
Notes:		"MedlineHuppe, Tobias Lorenz, Dominik Wachowiak, Mario Maurer, Felix Meiser, Andreas Groesdonk, Heinrich Fink, Tobias Sessler, Daniel I Kreuer, Sascha eng England 2017/08/24 BMC Pulm Med. 2017 Aug 22; 17(1):116. doi: 10.1186/s12890-017-0460-0"