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Erschienen in:
01.01.2004 | Original
Compartmentalisation of cytokines and cytokine inhibitors in ventilator-associated pneumonia
Erschienen in: Intensive Care Medicine | Ausgabe 1/2004
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Objective
To examine whether cytokine concentrations change in the pulmonary compartment during the development of ventilator-associated pneumonia (VAP).
Design
Non-directed bronchial lavage (NBL) was performed every 48 h in critically ill mechanically ventilated patients. Serial measurements of the cytokines tumor necrosis factor (TNF) α, interleukin (IL)-1α, IL-1β, IL-6, and IL-10 and the cytokine inhibitors soluble TNFα receptor type I (sTNFαRI), IL-1 receptor antagonist (IL-1Ra) and soluble IL-1 receptor II (sIL-1RII) were performed on the NBL fluid and matching plasma samples by ELISA.
Setting
An adult medical and surgical university hospital intensive care unit.
Patients
Nine patients who developed VAP and nineteen patients who did not develop VAP served as controls.
Interventions
None.
Results
Plasma concentrations of the measured cytokines and cytokine inhibitors did not change significantly in any patients. In control patients, NBL fluid concentrations of sIL-1RII decreased significantly over time (P=0.01). In patients who developed VAP, NBL fluid concentrations of TNFα, sTNFαRI, IL-1α, and IL-1β increased significantly (P=0.002, P=0.03, P=0.04 and P=0.02, respectively). Furthermore, NBL fluid/plasma concentration ratios for TNFα, sTNFαRI, IL-1α, IL-1Ra and IL-6 increased significantly as VAP developed (P=0.001, P=0.001, P=0.04, P=0.03, and P=0.04, respectively).
Conclusion
Our results suggest that the production of important cytokines and cytokine inhibitors is compartmentalised within the lung in critically ill mechanically ventilated patients who develop VAP.