PT  - JOURNAL ARTICLE
AU  - G. Choi
AU  - M.J. Schultz
AU  - J.W.O. van Till
AU  - P. Bresser
AU  - J.S. van der Zee
AU  - M.A. Boermeester
AU  - M. Levi
AU  - T. van der Poll
TI  - Disturbed alveolar fibrin turnover during pneumonia is restricted to the site of infection
AID  - 10.1183/09031936.04.00140703
DP  - 2004 Nov 01
TA  - European Respiratory Journal
PG  - 786--789
VI  - 24
IP  - 5
4099  - http://erj.ersjournals.com/content/24/5/786.short
4100  - http://erj.ersjournals.com/content/24/5/786.full
SO  - Eur Respir J2004 Nov 01; 24
AB  - Severe infection is associated with profound alterations in the systemic haemostatic balance, with activation of coagulation and suppressed fibrinolysis. Within the alveolar compartment, similar disturbances have been described during pulmonary inflammation. The current authors investigated whether local haemostasis was influenced during ventilator-associated pneumonia (VAP). In five patients with unilateral VAP, bronchoalveolar lavage fluid (BALF) was obtained from both the infected site (as identified on chest radiograph) and the contralateral noninfected lung (with no clinical or radiographic abnormalities). Markers for coagulation and fibrinolysis were compared between infected and noninfected lungs. A total of 10 healthy volunteers and 10 mechanically ventilated patients without pneumonia served as controls. Strong activation of coagulation (high levels of thrombin-antithrombin complexes, soluble tissue factor and factor VIIa) was detected in BALF from infected lungs, compared with that from noninfected lungs and controls. Furthermore, in infected lungs, fibrinolysis was depressed, with high levels of plasminogen activator inhibitor type 1. In conclusion, ventilator-associated pneumonia is characterised by a hypercoagulant state at the site of infection.