Angiotensin II formation and endothelin clearance in ARDS patients in supine and prone positions |
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Authors: | M. Wenz B. Hoffmann J. Bohlender G. Kaczmarczyk |
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Affiliation: | Clinic of Anesthesiology and Operative Intensive Medicine, Universit?tsklinikum Charité Campus Virchow-Klinikum, Berlin, Germany, DE Max Delbrück Center for Molecular Medicine and Franz Volhard Clinic, Virchow-Klinikum, Humboldt-University, Berlin, Germany, DE AG Experimental Anesthesia, Clinic of Anesthesiology and Operative Intensive Medicine, Universit?tsklinikum Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany e-mail: gabriele.kaczmarczyk@charite.de Tel.: + 30-4 50-5 10 22 Fax: + 30-4 50-5 19 02, DE
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Abstract: | Objective: In patients with acute respiratory distress syndrome (ARDS), the prone position may enhance oxygenation by changing ventilation/perfusion ratio. In this study, we investigated whether the prone position affects the net balance between pulmonary endothelin (ET-1) and angiotensin II (Ang II) production and clearance, two metabolic functions of lung endothelial cells.¶Setting: Anaesthesiological intensive care unit of a university hospital.¶Patients: Ten ARDS patients (Murray score > 2.5) were studied in both the supine position (SP) and the prone position (PP).¶Measurements and design: Blood samples were taken simultaneously from the patient in SP for assessment of mixed venous and arterial ET-1 and Ang II concentrations, and plasma renin concentration (PRC). This was repeated after 60 min in SP, immediately after turning the patient into PP, and 60 min thereafter. Net arterial/mixed venous ET-1 clearances and net Ang II formations were calculated.¶Results: arterial oxygen tension increased from SP to PP by an average of 60 mmHg, about 20 %. Arterial ET-1 concentrations of ARDS patients were 1.57 ± 1.1 pg/ml (mean ± SD) and within the range of healthy persons. Net ET-1 clearances were negative in SP, indicating pulmonary release of ET-1, and did not change in PP. Arterial Ang II concentrations (73 ± 56 pg/ml) as well as PRC (126 ± 85 pg/ml) were markedly elevated. Net transpulmonary Ang II formation did not change.¶Conclusion: Acute changes of oxygenation in ARDS patients by positioning do not induce any short-term effects on pulmonary ET-1 net clearance or Ang II net formation. |
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Keywords: | ARDS (acute respiratory distress syndrome) Angiotensin II (Ang II) Renin-angiotensin system (RAS) Endothelin (ET-1) Prone position ICU patients |
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