Bronchoalveolar lavage fluid characteristics of early intermediate and late phases of ARDS. Alterations in leukocytes, proteins, PAF and surfactant components.
OBJECTIVE
To determine the concentration of proteins and phospholipids, markers of inflammatory reaction such as platelet-activating factor (PAF), and cell alterations in bronchoalveolar lavage (BAL) fluid during the evolution of the acute respiratory distress syndrome (ARDS).


METHODS
Prospective controlled study.


METHODS
14-bed medical-surgical intensive care unit in a 750-bed university teaching hospital.


METHODS
19 mechanically ventilated patients, 9 patients with ARDS and 10 patients without cardiopulmonary disease (controls), were eligible for this study.


METHODS
BAL was performed during the early, intermediate, and late phases of ARDS.


RESULTS
Total phospholipids and individual phospholipid classes of the surfactant, proteins, PAF, and cells were measured. High levels of PAF, an increase in neutrophils and proteins, and quantitative as well as qualitative alterations in phospholipids in BAL fluid were observed in ARDS patients compared to the control group. PAF, proteins, and neutrophils were higher in early ARDS than in intermediate or late ARDS. The surfactant pool increased in the early phase and decreased in the intermediate or late phase of the syndrome. The qualitative alterations of surfactant consist of reduced phospholipid content in the surfactant structures with good surface properties; moreover, there was a considerable decrease in the percentage of phosphatidylcholine and phosphatidylglycerol, followed by an increase in phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, and sphingomyelin in all three phases of ARDS compared to the control group. Lysophosphatidylcholine was detectable only in late ARDS.


CONCLUSIONS
Total surfactant phospholipids, surfactant components, and inflammatory markers such as PAF, cells, and proteins were affected in patients with ARDS. These factors, undergoing quantitative alterations during the course of ARDS, could have a significant role in the pathogenesis and evolution of ARDS.
Nakos
G
G
Intensive Care Unit, University Hospital of Ioannina, Greece. gnakos@compulink.gr
Kitsiouli
E I
EI
Tsangaris
I
I
Lekka
M E
ME
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry* / Q000166:cytology*; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010972:Platelet Activating Factor / Q000032:analysis*; D011379:Prognosis; D011446:Prospective Studies; D011506:Proteins / Q000032:analysis*; D011663:Pulmonary Surfactants / Q000032:analysis* / Q000737:chemistry; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D013997:Time Factors
D015415:Biomarkers; D010972:Platelet Activating Factor; D011506:Proteins; D011663:Pulmonary Surfactants