Document Detail


Ventilator-associated pneumonia and atelectasis: evaluation through bronchoalveolar lavage fluid analysis.
MedLine Citation:
PMID:  12595981     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Surfactant offers protection against alveolar collapse and contributes to the local defense mechanism, but it is unclear if surfactant alterations have a role in the development of atelectasis or ventilator-associated pneumonia (VAP). The present study was undertaken to monitor surfactant, as well as biochemical BAL fluid alterations, during the course of VAP and atelectasis in mechanically ventilated patients without primary cardiopulmonary disease, to elucidate the pathogenesis and to differentiate these two entities. DESIGN. Prospective controlled study. SETTING: 14-bed general ICU of a 750-bed University Hospital. PATIENTS: Sixty-one ventilated patients, without primary cardiopulmonary disease-normal initial chest X-ray, satisfactory oxygenation (PaO(2)/FiO(2)>300 mmHg), and expected time of ventilation exceeding 2 weeks-were initially enrolled. Twelve of them developed VAP and eight lobar or segmental atelectasis during the 2-week study period. INTERVENTIONS: An initial BAL was performed in all patients within 48 h from admission. Patients who developed VAP or atelectasis were subjected to a second and third BAL during and after the resolution of VAP or atelectasis, respectively. MEASUREMENTS AND RESULTS: VAP and atelectasis resulted in a significant increase of total protein and markers of inflammation, such as PAF and neutrophils, which partially remitted after their resolution. Large surfactant aggregates, which contribute to surface tension decrease, were significantly reduced during both entities and remained low even after their resolution. CONCLUSIONS: BAL alterations during VAP and atelectasis suggest increased alveolar-capillary permeability, severe surfactant abnormalities, and signs of local inflammatory reaction. These alterations are associated with the observed deteriorated gas exchange and lung mechanics and could predispose to further lung injury in ventilated patients.
Authors:
G Nakos; H Tsangaris; S Liokatis; E Kitsiouli; M E Lekka
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-02-21
Journal Detail:
Title:  Intensive care medicine     Volume:  29     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-16     Completed Date:  2003-10-02     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  555-63     Citation Subset:  IM    
Affiliation:
Intensive Care Unit Department, University Hospital of Ioannina, University Street, 45500, Ioannina, Greece. gnakos@cc.uoi.gr
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Bronchoalveolar Lavage Fluid / microbiology*
Bronchoscopy
Female
Humans
Male
Pneumonia / complications,  etiology*,  microbiology
Prospective Studies
Pulmonary Atelectasis / complications,  etiology*
Pulmonary Surfactants
Respiration, Artificial / adverse effects*
Statistics, Nonparametric
Chemical
Reg. No./Substance:
0/Pulmonary Surfactants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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