[Ventilator bundle treatment of acute respiratory distress syndrome and its correlation with biomarkers of inflammation].

OBJECTIVE: To observe the levels of blood soluble urokinase plasminogen activator receptor (suPAR), receptor of advanced glycation end products (RAGE), procalcitonin (PCT) and C-reactive protein (CRP), and to investigate the effect of ventilator bundle (VB) on prognosis of patients with acute respiratory distress syndrome (ARDS).

METHODS: A prospective controlled study was conducted. A total of 54 cases of ARDS patients admitted to Department of Critical Care Medicine of the Second Hospital of Lanzhou University who received treatment of invasive mechanical ventilation between January 2013 and December 2013 were enrolled. All of the patients were given VB, and then divided into completely dependent group (VB group, n=29) and non-completely dependent group (NVB group, n=25) according to the dependence. The mechanical ventilation time, intensive care unit (ICU) length of stay, the incidence of ventilator associated pneumonia (VAP), the incidence of complications and 28-day mortality rate were compared between two groups. The blood suPAR, RAGE, PCT and CRP levels before and after treatment were determined. The correlations between oxygenation index (PaO(2)/FiO(2)) and other variables were analyzed by Pearson correlation and linear regression analysis.

RESULTS: (1) There was no significant difference in gender, age, acute physiology and chronic health evaluationII (APACHE II) score and PaO(2)/FiO(2), as well as other basic state between two groups. (2) There was no obvious difference in suPAR, RAGE, PCT and CRP levels before treatment between two groups. The levels of above parameters were significantly decreased after treatment. The blood suPAR and RAGE levels in VB group were significantly decreased compared with those in NVB group [suPAR: 189.87 (135.57) ng/L vs. 309.38 (278.00) ng/L, RAGE: 2.17 (0.75) μg/L vs. 3.17 (2.64) μg/L, both P<0.01]. (3) Compared with NVB group, the mechanical ventilation time, ICU length of stay, and the incidence of VAP in VB group were significantly reduced (mechanical ventilation time: 131.52 ± 44.94 hours vs. 166.28 ± 38.09 hours, t=-3.039, P=0.004; ICU length of hospital stay: 171.14 ± 74.25 hours vs. 210.92 ± 54.89 hours, t=-2.208, P=0.032; incidence of VAP: 17.24% vs. 44.00%, χ² = 4.611, P=0.041), but 28-day mortality rate (27.59% vs. 36.00%, χ² = 0.441, P=0.566) and rates of other related complication showed no significant difference between VB group and NVB group. (4) Correlation analysis showed that PaO(2)/FiO(2) was negatively correlated with age (r=-0.290, P=0.033), suPAR (r=-0.898, P=0.000), RAGE (r=-0.898, P=0.000), PCT (r=-0.486, P=0.000) and CRP (r=-0.280, P=0.040). (5) The linear regression analysis showed PaO(2)/FiO(2) and suPAR (t=2.645, P=0.011), RAGE (t=-2.885, P=0.006), PCT (t=2.649, P=0.011) were significantly negatively co-related.

CONCLUSIONS: Blood suPAR, RAGE, PCT and CRP levels were correlated with the severity of ARDS patients. Compliance of VB can affect the prognosis of patients with ARDS. The high compliance of patients can significantly decrease the levels of blood pro-inflammatory markers, shorten the mechanical ventilation time and ICU length of stay, reduce the incidence of VAP, and it showed a positive impact on patients' prognosis.