BAL induces an increase in peripheral blood neutrophils and cytokine levels in healthy volunteers and patients with pneumonia

Study objectives: To examine the peripheral effects of BAL on the neutrophi l counts and cytokine levels in the circulation, Design and methods: WBC counts and plasma cytokines were measured before an d 4 h after fiberoptic bronchoscopy (FOB) without further interventions (n = 6), or combined with BAL in normal volunteer subjects (n = 6), and in pat ients with bacterial pneumonia (n = 4), The bronchus of the right middle lo be was wedged, and three 50-mL aliquots of sterile saline solution was inst illed, There was no endotoxin contamination in the saline solution or the f luid obtained through the working channel of bronchoscope, Results: In volunteers, peripheral WBC counts and the number of nonsegmente d and segmented neutrophils increased after the BAL procedure (p < 0.05) as sociated with the increase in plasma concentration (mean +/- SEM) of interl eukin (1L)-6 (0.99 +/- 0.32 pg/mL before BAL and 20.38 +/- 13.42 pg/mL alte r BAL; p < 0.05) and granulocyte colony-stimulating factor (G-CSF; 14.1 +/- 1.7 pg/mL before BAL and 38.5 +/- 9.7 pg/mL alter BAL; p < 0.05). The incr ease in WBC counts and neutrophil counts was positively correlated to the i ncrease in IL-6 (p < 0.05) and the increase in G-CSF (p < 0,05), In patient s with pneumonia, 1L-6 and G-CSF levels were higher after BAL than in norma l volunteer subjects (p < 0,05), There was no increase in plasma concentrat ion of IL-1 beta, tumor necrosis factor-alpha, or 1L-8 after BAL in normal volunteer subjects or in patients with pneumonia, FOE without BAL did not i ncrease the WBC count, neutrophil count, or plasma cytokine levels. Conclusion: The BAL procedure increases the number of WBCs, and segmented a nd nonsegmented neutrophils in the peripheral circulation as well as circul ating IL-6 and G-CSF levels.