Changes in the inflammatory response of the lung during acute respiratory distress syndrome: prognostic indicators.
We studied paired bronchoalveolar lavage (BAL) in patients with sepsis-associated acute respiratory distress syndrome (ARDS). Patients were evaluated at one institution and underwent bronchoscopy with BAL within 48 h of the onset of ARDS. Patients were restudied with bronchoscopy and BAL after 4 d of treatment. Fifty-eight patients were initially studied, with 44 patients having follow-up bronchoscopy after 4 d. The overall 30-d survival for the ARDS group was 60%. In the initial lavage, there was no difference in the neutrophils between the survivors and nonsurvivors (survivors: 59 [0-98]%; Median [Range]; nonsurvivors: 55 [0-92]%). The follow-up lavage demonstrated a significant drop in the neutrophils for the survivors (36 [4-89]%, p < 0.002) which was not seen for the nonsurvivors (70 [26-95]%). Initial IL-8 concentrations in the BAL fluid were not significantly different between the two groups. In the follow-up lavage, there was a significant fall for the IL-8 concentrations for the survivors but not the nonsurvivors. We conclude that neutrophil influx in ARDS may rapidly resolve within a week of the onset of ARDS. The resolution of neutrophils was associated with a good prognosis.
Baughman
R P
RP
Division of Pulmonary and Critical Care Medicine, University of Cincinnati, Ohio 45267-0564, USA.
Gunther
K L
KL
Rashkin
M C
MC
Keeton
D A
DA
Pattishall
E N
EN
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D016209:Interleukin-8 / Q000032:analysis; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality / Q000473:pathology*; D018805:Sepsis / Q000150:complications; D015996:Survival Rate
D016209:Interleukin-8