Document Detail

Inflammatory mediators in bronchoalveolar lavage fluid and plasma in leukocytopenic patients with septic shock-induced acute respiratory distress syndrome.
MedLine Citation:
PMID:  9671368     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The acute respiratory distress syndrome (ARDS) is a frequent complication of severe sepsis and a major cause of death in patients with hematologic malignancy during chemotherapy-induced leukocytopenia. Inflammatory mediators are important modulators of host response to injury and have been found to be increased in the bronchoalveolar lavage (BAL) fluid of nonleukocytopenic patients with ARDS. Since inflammatory cytokines in plasma of nonleukocytopenic patients seem to be efficient predictors of the course of ARDS, we examined this hypothesis in leukocytopenic patients with septic shock-induced ARDS. DESIGN: Prospective, observational study. SETTING: Intensive care unit (ICU) of a university hospital. PATIENTS: Nineteen patients with leukocytopenia (white blood cell count of <1/nL) following cytoreductive chemotherapy for malignant disorders and severe sepsis with shock-induced ARDS (Murray score of >2.5). INTERVENTIONS: BAL and plasma sampling and ICU management. MEASUREMENTS AND MAIN RESULTS: The proinflammatory cytokines tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-8 were measured in the BAL aspirates and in plasma samples, both obtained within 18 hrs after onset of ARDS. Hemodynamic and oxygen metabolism data were measured immediately before plasma samples were taken and BAL was performed. Of the 19 patients studied, nine patients responded to ICU treatment (e.g., mechanical ventilation as indicated by PaO2/FIO2, FIO2, shunt volume, and course of pulmonary infiltrates), whereas ten patients did not respond. BAL cytokine concentrations were significantly increased in nonresponders in comparison with responding patients (TNF-alpha, p = .021; IL-6, p = .008; IL-8, p = .019). In contrast, we did not observe any differences between the groups in terms of plasma cytokine concentrations. CONCLUSION: Determination of cytokine concentrations in BAL samples may be useful for evaluation of severity and course of ARDS in leukocytopenic patients, whereas measurement of plasma cytokines is not helpful.
M G Kiehl; H Ostermann; M Thomas; C Müller; U Cassens; J Kienast
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  26     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-08-07     Completed Date:  1998-08-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1194-9     Citation Subset:  AIM; IM    
Department of Internal Medicine, University of Muenster, Germany.
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MeSH Terms
Biological Markers / analysis*
Bronchoalveolar Lavage Fluid / immunology*
Cytokines / metabolism*
Drug Therapy / adverse effects
Intensive Care / methods*
Interleukin-6 / metabolism
Interleukin-8 / metabolism
Leukopenia / chemically induced,  immunology*
Middle Aged
Prospective Studies
Respiratory Distress Syndrome, Adult / immunology*,  microbiology
Shock, Septic / immunology*,  microbiology
Tumor Necrosis Factor-alpha / metabolism
Reg. No./Substance:
0/Biological Markers; 0/Cytokines; 0/Interleukin-6; 0/Interleukin-8; 0/Tumor Necrosis Factor-alpha
Comment In:
Crit Care Med. 1998 Jul;26(7):1151-2   [PMID:  9671356 ]

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