Copyright ©ERS Journals Ltd 2001 Systemic inflammatory response after bronchoalveolar lavage in critically ill patients1 Institute of Pneumology and Thoracic Surgery, Hospital Clinic de Barcelona and 2 Biochemistry, Hospital Clinic, University of Barcelona, Barcelona, Spain CORRESPONDENCE: A. Torres, Hospital Clínic de Barcelona, Institut de Pneumologia: Toràcica, Villarroel, 170, 08036, Barcelona, Spain. Fax: +34 93 227 54 54 Keywords: bronchoalveolar lavage, diagnosis, intensive care unit, interleukins, inflammatory response, pneumonia
Received: March 23, 2000
This work was supported by: Fondo de investigación Sanitaria (FIS) Grant #: 98/1096, 1997, Suport dels Grups de Recerca (SGR) Grant #: 00086, IDIBAPS, Comissió Interdepartmental de Recerca i Innovació Tecnológica (CIRIT, 1999), the European Respiratory Society (ERS), and the Bochumer Arbeitskreis für Peumologie und Allergologie (BAPA).
Bronchoscopic bronchoalveolar lavage (BAL) may be followed by a systemic inflammatory response. Previous reports have suggested pneumonia as a predisposing condition and systemic cytokines as possible mediators.
To test this hypothesis, systemic levels of interleukin (IL)-1ß, IL-6 and tumour necrosis factor-alpha (TNF-
Pa,O2/FI,O2 ratio was lower at 12 h compared to baseline in patients with pneumonia (baseline median 192 (range 65256); 12 h 160 (66190) mmHg, p<0.001) and ventilated controls (baseline 293 (205473); 12 h 226 (153330) mm Hg p=0.011), but returned to baseline levels at 24 h (pneumonia: 194 (92312), p=0.991; controls: 309 (173487) mmHg, p=0.785). No changes in other clinical variables were observed. Systemic TNF-
No deterioration of clinical variables and no increase in systemic cytokine release has been observed after bronchoalveolar lavage, in critically ill patients. The potential cytokine increase is probably too small, in relation to the pre-existing inflammatory response, to yield clinical significance in this population otherwise antibiotic therapy may have been protective.
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