Elevation of procalcitonin after implantation of an interventional lung assist device in critically ill patients

A pumpless interventional arteriovenous lung assist device (iLA) facilitates the removal of carbon dioxide from the blood and is used as part of the lung-protective ventilation strategy in patients with acute respiratory distress syndrome (ARDS). In case of bacterial infection, delayed antimicrobial...

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Published inASAIO journal (1992) Vol. 60; no. 2; p. 249
Main Authors Kott, Matthias, Bewig, Burkhard, Zick, Günther, Schaedler, Dirk, Becher, Tobias, Frerichs, Inéz, Weiler, Norbert
Format Journal Article
LanguageEnglish
Published United States 01.03.2014
Subjects
Adult
Aged
Calcitonin - blood
Calcitonin Gene-Related Peptide
Critical Illness
Female
Humans
Male
Middle Aged
Protein Precursors - blood
Respiration, Artificial - instrumentation
Respiratory Distress Syndrome, Adult - therapy
Retrospective Studies
Ventilators, Mechanical - adverse effects
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Summary:A pumpless interventional arteriovenous lung assist device (iLA) facilitates the removal of carbon dioxide from the blood and is used as part of the lung-protective ventilation strategy in patients with acute respiratory distress syndrome (ARDS). In case of bacterial infection, delayed antimicrobial therapy increases the mortality in this group of high-risk critically ill patients, whereas overtreatment promotes bacterial resistance and leads to increased drug toxicity and costs. Besides clinical signs and symptoms, antimicrobial treatment is based on the kinetics of biomarkers such as procalcitonin (PCT). We hereby report an up to 10-fold increase in PCT serum concentrations in four mechanically ventilated patients with ARDS detected within 12-20 hours after iLA implantation in the absence of any infection. Procalcitonin concentrations returned to nearly baseline values in all patients on the fourth day after iLA implantation. We discuss the possible mechanisms of PCT induction in this specific patient population and recommend the onset of antibiotics administration after iLA implantation to be carefully considered in the context of other clinical findings and not solely based on the PCT kinetics. Repeated PCT measurements in short time intervals should be performed in these patients.
ISSN:1538-943X
DOI:10.1097/MAT.0000000000000041