Journal of Critical Care
Volume 26, Issue 3 , Pages 249-256, June 2011

Alveolar fluid clearance is faster in women with acute lung injury compared to men☆☆☆

  • Julie A. Bastarache, MD

      Affiliations

    • Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2650, USA
    • Corresponding Author InformationCorresponding author.
    • ,
  • Thida Ong, MD

      Affiliations

    • Department of Pediatrics, University of California, San Francisco, CA 94143, USA
    • ,
  • Michael A. Matthay, MD

      Affiliations

    • Departments of Medicine & Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA 94143, USA
    • ,
  • Lorraine B. Ware, MD

      Affiliations

    • Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2650, USA

published online 05 August 2010.

Abstract 

Purpose

Studies suggest that there is a sex difference in the development and outcomes of acute lung injury (ALI). Few studies have directly addressed the association of sex and alveolar fluid clearance (AFC), a process that is critical to ALI resolution.

Materials and Methods

To test the hypothesis that female sex is associated with an increased AFC rate, we measured AFC rates in 150 mechanically ventilated patients with acute pulmonary edema and a pulmonary edema fluid-to-plasma protein ratio (EF/PL) diagnostic of low permeability (EF/PL <0.65, n = 69) or high permeability (EF/PL ≥0.65, n = 81) edema. We measured protein concentration in serial samples of undiluted EF collected within 6 hours of intubation and calculated net rate of AFC. In addition, plasma levels of receptor for advanced glycation end products were measured as a surrogate marker for alveolar epithelial injury.

Results

In patients with ALI, women had higher rates of net AFC at 4 hours compared to men (11.9% per hour vs 4.3% per hour, P = .017) and more women had maximal rates of AFC. There were no differences in circulating levels of receptor for advanced glycation end products between men and women.

Conclusions

These findings may have significant implications for future ALI studies and potential therapies.

Keywords: Gender, Acute respiratory distress syndrome, Mortality, Receptor for advanced glycation end products, Pulmonary edema

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☆ Authors' contributions: JAB was responsible for experimental, data analysis and interpretation, and manuscript preparation, TO assisted with data analysis and manuscript preparation, MAM collected the UCSF patient samples, was responsible for the protein measurements, and assisted with data interpretation and manuscript preparation. LBW conceived the study and was responsible for collecting the Vanderbilt samples and making the protein measurements, experimental design, data interpretation, and manuscript preparation. All authors read and approved the final manuscript.

☆☆ The following were the grants received: NIH/NICHD 5 K12 HD 043483-05 and HL090785-01A1 to JAB, UCSF Pediatric Training Grant 5 T32 HD049303 to TO, NHLBI HL51856 to MAM, and NIH HL081332 and NIH HL088263 to LBW HL103836.

PII: S0883-9441(10)00168-1

doi:10.1016/j.jcrc.2010.06.005

Journal of Critical Care
Volume 26, Issue 3 , Pages 249-256, June 2011

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