DIFFERENT PATTERN OF LOCAL AND SYSTEMIC RELEASE OF PROINFLAMMATORY AND ANTIINFLAMMATORY MEDIATORS IN SEVERELY INJURED PATIENTS WITH CHEST TRAUMA

Background: Excessive release of proinflammatory cytokines has been in volved in pathogenesis of acute respiratory distress syndrome. Design: Since injured patients with chest trauma reveal a high risk for postt raumatic acute respiratory distress syndrome, local and systemic relea se of proinflammatory cytokines and their naturally occurring inhibito rs were determined in the early posttraumatic period. Materials and Me thods: Proinflammatory and anti-inflammatory mediators were measured i n plasma and bronchoalveolar lavage fluid (BALE) from 16 patients with multiple injuries including severe chest injury (Injury Severity Scor e of 34.4 +/- 2.3 points) and compared with healthy volunteers (n = 17 ). Results: Tumor necrosis factor-alpha was detectable neither in plas ma nor in BALE. Interleukin-1 beta and interleukin-8 were significantl y increased in BALF from injured patients, while plasma levels were si milar in both groups. Soluble tumor necrosis factor receptors p55 and p75 and interleukin-1ra were markedly elevated in plasma (p less than or equal to 0.01) and BALE (p less than or equal to 0.001) from injure d patients compared with controls. Conclusion: Highly increased concen trations of proinflammatory cytokines in BALF, but not in circulation, indicate a strong local inflammatory response early after multiple in juries combined with chest injury rather than severe systemic inflamma tion. In contrast, anti-inflammatory mechanisms seem to be activated l ocally and systemically.