BRONCHOALVEOLAR LAVAGE FLUID CHARACTERISTICS OF EARLY INTERMEDIATE AND LATE PHASES OF ARDS - ALTERATIONS IN LEUKOCYTES, PROTEINS, PAF AND SURFACTANT COMPONENTS
G. Nakos et al., BRONCHOALVEOLAR LAVAGE FLUID CHARACTERISTICS OF EARLY INTERMEDIATE AND LATE PHASES OF ARDS - ALTERATIONS IN LEUKOCYTES, PROTEINS, PAF AND SURFACTANT COMPONENTS, Intensive care medicine, 24(4), 1998, pp. 296-303
Objective: To determine the concentration of proteins and phospholipid
s, markers of inflammatory reaction such as platelet-activating factor
(PAF), and cell alterations in bronchoalveolar lavage (BAL) fluid dur
ing the evolution of the acute respiratory distress syndrome (ARDS). D
esign: Prospective controlled study. Setting: 14-bed medical-surgical
intensive care unit in a 750-bed university teaching hospital. Patient
s: 19 mechanically ventilated patients, 9 patients with ARDS and 10 pa
tients without cardiopulmonary disease (controls), were eligible for t
his study. Interventions: BAL was performed during the early, intermed
iate, and late phases of ARDS. Measurements and results: Total phospho
lipids and individual phospholipid classes of the surfactant, proteins
, PAF, and cells were measured. High levels of PAF, an increase in neu
trophils and proteins, and quantitative as well as qualitative alterat
ions in phospholipids in BAL fluid were observed in ARDS patients comp
ared to the control group. PAE proteins, and neutrophils were higher i
n early ARDS than in intermediate or late ARDS. The surfactant pool in
creased in the early phase and decreased in the intermediate or late p
hase of the syndrome. The qualitative alterations of surfactant consis
t of reduced phospholipid content in the surfactant structures with go
od surface properties; moreover, there was a considerable decrease in
the percentage of phosphatidylcholine and phosphatidylglycerol, follow
ed by an increase in phosphatidylethanolamine, phosphatidylserine, pho
sphatidylinositol, and sphingomyelin in all three phases of ARDS compa
red to the control group. Lysophosphatidylcholine was detectable only
in late ARDS. Conclusion: Total surfactant phospholipids, surfactant c
omponents, and inflammatory markers such as PAF, cells, and proteins w
ere affected in patients with ARDS, These factors, undergoing quantita
tive alterations during the course of ARDS, could have a significant r
ole in the pathogenesis and evolution of ARDS.