Persistent Elevation of Inflammatory Cytokines Predicts a Poor Outcome in ARDS

Meduri, G. Umberto; Headley, Stacey; Kohler, Gary; Stentz, Frankie B.; Tolley, Elizabeth A.; Umberger, Reba; Leeper, Kenneth V.

doi:10.1378/chest.107.4.1062

Cited by 704 publications

(201 citation statements)

References 41 publications

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“…Respiratory infections are not an exception and are a stimulus for the activation of the inflammatory response at both the local and systemic levels [11]. The association between high levels of cytokines, such as IL-6, and acute respiratory distress syndrome is well documented [12][13][14]. This cytokine has been identified as a marker of the severity of pneumonia caused by the Influenza A (H 1 N 1 ) virus.…”

Section: Resultsmentioning

confidence: 99%

Cytokine levels in bronchoalveolar lavage and serum in 3 patients with 2009 Influenza A(H1N1)v severe pneumonia

Estella

2011

J Infect Dev Ctries

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Introduction: Pandemic Influenza A (H 1 N 1 )v pneumonia has led to a notable increase of admissions to intensive care units. A cytokinemediated inflammatory response has been well documented in pneumonia and acute respiratory distress syndrome. However, few studies have focused on the role of these inflammatory mediators in infections caused by the Influenza A (H 1 N 1 )v. In this study, we assess the inflammatory response mediated by cytokines at the local and systemic levels in three cases of severe pneumonia caused by Influenza A (H 1 N 1 ) virus. Methodology: Serum and bronchoalveolar lavage samples were obtained from three mechanically ventilated patients diagnosed with Influenza A (H1N1) virus pneumonia by bronchoscopic bronchoalveolar lavage. Levels of interleukin 6 (IL-6), interleukin 8 (IL-8), tumour necrosis factor alpha (TNFα) and interleukin 1 beta (IL-1ß) were meassured in these samples by enzyme-linked immunosorbent assay (ELISA). Results: High levels of C Reactive Protein, Procalcitonin below 1 ng/ml and absence of leukocytosis were common findings in all patients. TNF α and IL-1ß were not detected in the serum. IL-6 levels in serum were (94, pg/ml, 77 pg/ml and 84 pg/ml) respectively in the three patients, while IL-8 levels were (30,2 pg/ml, 128 pg/ml and 40,5 pg/ml). In the BAL samples, only one of the analysed cytokines, IL-1ß was present at detectable levels in two patients (21 pg/ml and 11 pg/ml respectively). Conclusions: Our results support previous findings which suggest that high levels of IL-6 and IL-8 in serum somehow participate in the inflammatory response in severe cases of pandemic influenza pneumonia.

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Section: Resultsmentioning

confidence: 99%

Cytokine levels in bronchoalveolar lavage and serum in 3 patients with 2009 Influenza A(H1N1)v severe pneumonia

Estella

2011

J Infect Dev Ctries

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“…It also supports the current understanding of the multifaceted pathophysiology seen in ARDS. These abnormalities include changes in response to certain types of primary injury (chemical, infectious), evidence of surfactant depletion, surfactant dysfunction, and the presence of inflammatory markers such as cytokines [1,10,18,25,28,29,34,41]. In this animal study, we targeted two of these ARDS abnormalities in the SL+L group, demonstrating the effectiveness of combination drug therapy administered directly into the lung by lavage.…”

Section: Discussionmentioning

confidence: 94%

“…Indeed, ARDS is a complex multifaceted disorder for which surfactant dysfunction is only one aspect. Direct injury to the lung can occur from the offending agent, as well as induce an inflammatory response to further aggravate the lung injury [1,10,18,25,28,29,34,41]. Therefore, any successful treatment of ARDS would ideally incorporate more than one therapeutic target.…”

Section: Introductionmentioning

confidence: 99%

Surfactant Lavage with Lidocaine Improves Pulmonary Function in Piglets after HCl-Induced Acute Lung Injury

Huang

Uyehara

Balaraman

et al. 2004

Lung

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Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. The pathophysiology of ARDS includes abnormalities of surfactant function as well as pulmonary inflammation. Immunomodulating drugs, like Lidocaine, have shown some success in decreasing inflammation in ARDS. We attempted to combine surfactant lavage's ability to reverse the surfactant dysfunction, while acting as a vehicle to deliver Lidocaine. Gravity-driven surfactant (Infasurf) lavage (35 ml/kg) was administered alone or mixed with Lidocaine after severe HCl acid injury (0.3N; 3cc/kg) in neonatal piglets. Treatment groups included: control (C) (n = 5), surfactant lavage (SL) (35 ml/kg-diluted Infasurf) (n = 7) and SL mixed with Lidocaine (SL+L) (n = 7). About 26-27% of the lavage was retained (phospholipid 73-74 mg/kg; Lidocaine 1.8 mg/kg). Oxygenation progressively increased in the SL and SL+L groups over the 4-hour period (at 240 min: C = 99 ± 14; SL = 154 ± 39; SL+L = 230 ± 40 mmHg) (p < 0.05). PaCO 2 increased in all groups from 43± 0.3to 55 ± 0.7 mmHg. Only SL+L showed a reduction in PaCO 2 (at 240 min: C = 54 ± 4; SL = 53 ± 7; SL +L = 49 ± 2 mmHg) (p < 0.05). Finally, SL and SL + L had superior characteristics during the quasistatic pressure volume (PV) procedure as compared to Control (p < 0.05). In our HCl ALI model, SL improved oxygenation and quasi-static lung compliance over C. The pulmonary function effects of SL were further enhanced by the addition of Lidocaine to the surfactant suspension. Combining therapeutic agents with surfactant lavage may be an effective strategy in ALI.

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“…First, elevated levels of IL‐6 in plasma and BAL have been shown in several studies to predict mortality in acute lung injury (Meduri et al. 1995; Parsons et al. 2005).…”

Section: Discussionmentioning

confidence: 99%

Bronchial microdialysis monitoring of inflammatory response in open abdominal aortic aneurysm repair; an observational study

et al. 2017

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Aortic surgery results in ischemia–reperfusion injury that induces an inflammatory response and frequent complications. The magnitude of the inflammatory response in blood and bronchi may be associated with the risk of immediate complications. The purpose of the study was to evaluate bronchial microdialysis as a continuous monitoring of cytokines in bronchial epithelial lining fluid (ELF) and to determine whether bronchial ELF cytokine levels reflect the ischemia–reperfusion injury and risk for complications during open abdominal aortic aneurysm (AAA) repair. We measured cytokines in venous blood using microdialysis and in serum for comparison. Sixteen patients scheduled for elective open AAA repair were included in a prospective observational study. Microdialysis catheters were introduced into a bronchi and a cubital vein. Eighteen cytokines were measured using a Bio‐Plex Magnetic Human Cytokine Panel. Samples were collected before and during cross‐clamping of the aorta as well as from 0 to 60 min and from 60 to 120 min of reperfusion. The ELF levels of several cytokines changed significantly during reperfusion. In particular, IL‐6 increased more than 10‐fold and IL‐13 more than 5‐fold during ischemia and reperfusion. Also, the venous levels of several inflammatory and anti‐inflammatory cytokines increased and exhibited their highest concentration during reperfusion. Both bronchial and venous cytokine levels correlated with duration of the procedure, intensive care days, and preoperative kidney disease. Three patients suffered organ failure as a direct consequence of the procedure, and in these patients the bronchial ELF concentrations of 17 of 18 cytokines differed significantly from patients without such complications. Bronchial microdialysis is suited for continuous monitoring of inflammation during open AAA repair. The bronchial ELF cytokine levels may be useful in predicting immediate complications such as organ failure in patients undergoing vascular surgery.

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Persistent Elevation of Inflammatory Cytokines Predicts a Poor Outcome in ARDS

Cited by 704 publications

References 41 publications

Cytokine levels in bronchoalveolar lavage and serum in 3 patients with 2009 Influenza A(H1N1)v severe pneumonia

Cytokine levels in bronchoalveolar lavage and serum in 3 patients with 2009 Influenza A(H1N1)v severe pneumonia

Surfactant Lavage with Lidocaine Improves Pulmonary Function in Piglets after HCl-Induced Acute Lung Injury

Bronchial microdialysis monitoring of inflammatory response in open abdominal aortic aneurysm repair; an observational study

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