RT Journal Article
SR Electronic
T1 Disturbed alveolar fibrin turnover during pneumonia is restricted to the site of infection
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 786
OP 789
DO 10.1183/09031936.04.00140703
VO 24
IS 5
A1 G. Choi
A1 M.J. Schultz
A1 J.W.O. van Till
A1 P. Bresser
A1 J.S. van der Zee
A1 M.A. Boermeester
A1 M. Levi
A1 T. van der Poll
YR 2004
UL http://erj.ersjournals.com/content/24/5/786.abstract
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.