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Effects of a recruitment maneuver on plasma soluble rage in patients with diffuse ARDS: a prospective randomized crossover study

Introduction

The soluble form of the receptor for advanced glycation endproducts (sRAGE) is a promising marker for epithelial dysfunction, but it has not been fully characterized as a biomarker during ARDS. Whether sRAGE could inform on the response to ventilator settings has been poorly investigated, and whether recruitment maneuver (RM) may influence plasma sRAGE remains unknown.

Methods

Twenty-four patients with moderate/severe, nonfocal ARDS were enrolled in this prospective monocentric crossover study and randomized into a 'RM-SHAM' group when a 6-hour-long RM sequence preceded a 6-hour-long sham evaluation period, or a 'SHAM-RM' group (inverted sequences). Protective ventilation was applied, and RM consisted of the application of 40 cmH2O airway pressure for 40 seconds. Arterial blood was sampled for gas analyses and sRAGE measurements, 5 minutes pre RM (or 40-second-long sham period), 5 minutes, 30 minutes, 1 hour, 4 hours and 6 hours after the RM (or 40-second-long sham period).

Results

Mean PaO2/FiO2, tidal volume, PEEP and plateau pressure were 125 mmHg, 6.8 ml/kg (ideal body weight), 13 and 26 cmH2O, respectively. Median baseline plasma sRAGE levels were 3,232 pg/ml. RM induced a significant decrease in sRAGE (-1,598 ± 859 pg/ml) in 1 hour (P = 0.043). At 4 and 6 hours post RM, sRAGE levels increased back toward baseline values. Pre-RM sRAGE was associated with RM-induced oxygenation improvement (AUC 0.87). See Figure 1.

Figure 1
figure1

Evolution of plasma levels of sRAGE (pg/ml) in both randomization sequences.

Conclusion

We report the first kinetics study of plasma sRAGE after RM in ARDS. Our findings could help to design future studies of sRAGE as a marker of response to therapeutic interventions during ARDS.

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Jabaudon, M., Hamroun, N., Roszyk, L. et al. Effects of a recruitment maneuver on plasma soluble rage in patients with diffuse ARDS: a prospective randomized crossover study. Crit Care 19, P241 (2015). https://doi.org/10.1186/cc14321

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Keywords

  • Ideal Body Weight
  • Ventilator Setting
  • Plateau Pressure
  • Sham Evaluation
  • Recruitment Maneuver