There is a growing interest in exhaled nitric oxide (NO) as a non-invasive marker of pulmonary inflammationand oxidative stress. Previous studies has focused on use of exhaled NO to diagnose and monitor the airwayinflammation in spontaneously breathing patients, However, few studies have involved mechanically ventilated(MV) patients. Airway inflammation and oxidative stress during MV tend to predispose to more seriouscomplications, such as acute lung injury. Thus exhaled NO analysis may also have a potential use in MVpatients. As an initial step, it is necessary to explore changes in levels of exhaled NO and its serum marker(serum nitrite [sNOa'- ]) over time in patients who require an artificial airway (which disrupts normal NO flowfrom the nose to the lower airways) and MV (which introduces confounding factors). The purpose of this studyis to examine changes in exhaled NO from the nose (nNO), exhaled NO from the lower ariways (LNO) andsNO2~ over time in: 1) spontaneously breathing patients undergoing tracheostomy or laryngectomy (T/L), and2) patients undergoing tracheostomy while on MV (T-MV). A prospective, 2x3 repeated measures design willbe used. Comparisons will be made between nNO, LNO and sNC>2~ obtained 1) pre-T/L, Day 1-3 post-T/L,and 1 week after in T/L patients, and 2) pre-tracheostomy, Day 1-3 post-tracheostomy, and 1 week after inT-MV patients. Statistical analysis will include descriptive statistics, 2x3 repeated measures MANCOVA, onewav repeated measures ANOVA and Soearman's rank correlation.
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