RT Journal Article
SR Electronic
T1 Transepithelial nasal potential difference in patients with, and at risk of acute respiratory distress syndrome
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 1099
OP 1107
DO 10.1136/thoraxjnl-2020-215587
VO 76
IS 11
A1 Mac Sweeney, Rob
A1 Reddy, Kiran
A1 Davies, Jane C
A1 Parker, Mike
A1 Kelly, Barry
A1 Elborn, J Stuart
A1 Conlon, John
A1 Verghis, Rejina M
A1 Calfee, Carolyn S
A1 Matthay, Michael A
A1 Alton, Eric W F W
A1 McAuley, Daniel F
YR 2021
UL http://thorax.bmj.com/content/76/11/1099.abstract
AB Background Impaired alveolar fluid clearance, determined in part by alveolar sodium transport, is associated with acute respiratory distress syndrome (ARDS). Nasal sodium transport may reflect alveolar transport. The primary objective of this prospective, observational study was to determine if reduced nasal sodium transport, as measured by nasal potential difference (NPD), was predictive of the development of and outcome from ARDS.Methods NPD was measured in 15 healthy controls and in 88 patients: 40 mechanically ventilated patients defined as ‘at-risk’ for ARDS, 61 mechanically ventilated patients with ARDS (13 who were previously included in the ‘at-risk’ group) and 8 ARDS survivors on the ward.Results In at-risk subjects, maximum NPD (mNPD) was greater in those who developed ARDS (difference –8.4 mV; 95% CI –13.8 to –3.7; p=0.005) and increased mNPD predicted the development of ARDS before its onset (area under the curve (AUC) 0.75; 95% CI 0.59 to 0.89). In the ARDS group, mNPD was not significantly different for survivors and non-survivors (p=0.076), and mNPD was a modest predictor of death (AUC 0.60; 95% CI 0.45 to 0.75). mNPD was greater in subjects with ARDS (−30.8 mV) than in at-risk subjects (−24.2 mV) and controls (−19.9 mV) (p<0.001). NPD values were not significantly different for survivors and controls (p=0.18).Conclusions Increased NPD predicts the development of ARDS in at-risk subjects but does not predict mortality. NPD increases before ARDS develops, is greater during ARDS, but is not significantly different for controls and survivors. These results may reflect the upregulated sodium transport necessary for alveolar fluid clearance in ARDS. NPD may be useful as a biomarker of endogenous mechanisms to stimulate sodium transport. Larger studies are now needed to confirm these associations and predictive performance.Data are available on reasonable request. De-identified participant data are freely available from Dr Kiran Reddy (kiranreddy@mater.ie) on reasonable request.