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Differential evaluation of bronchoalveolar lavage cells and leukotrienes in unilateral acture lung injury and ARDS patients

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Abstract

Patients with unilateral acute lung injury (UALI; n=6) and ARDS (n=4) were evaluated by bronchoalveolar lavage, as controls we used 5 patients suffering from cerebral hemorrhage and without pulmonary, cardiac or infectious disease who were mechanically ventilated. For each group of patients two independent bronchoalveolar lavages (BAL) were performed. The BAL fluid recovered from the two lungs was immediately analyzed for leukotrienes (LTS) by means of RP-HPLC and stained for cell counts. The BAL from the control group did not show any LTS and the percentage of neutrophils was within the normal range: 1±0.2% right lung and 1.2±0.4% left lung. The BAL fluid from UALI patients showed two different patterns, the injured lung showed high levels of LTS (39.1±8 ng ml-1 LTB4; 25±6 ng ml-1 LTD4 and 27.8±8.2 ng ml-111-trans LTC4) and an increased percentage of neutrophils (74.2±7%) compared to controls. Only 2 out of the 6 patients from the UALI group showed small amounts of LTB4 (4 ng ml-1) and LTD4 (3.2 ng ml-1). The BAL obtained from the “healthy lung” in both cases showed values of LTS almost eight fold lower than those present in the injured lung. The percentage of neutrophils from the unaffected lungs (4.3±7%) was not significantly different from controls. Lavage fluid from ARDS patients showed a similar picture to that of the affected lung from UALI patients. Evaluation of ARDS lavage fluid demonstrated the presence of the same LTS (LTB4, LTD4 and 11-trans LTC4) with concentrations similar to those found in the injured lung of UALI subjects. The amount of LTB4 (a very potent chemotatic factor) correlated directly with the percentage of neutrophils both in ARDS and the diseased lung of UALI patients. These findings suggest that LTS and neutrophils participate in the pathophysiology of UALI and ARDS, and that UALI is a localized pathologic entity similar to ARDS.

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Authors and Affiliations

  1. Institute of Anesthesiology and Intensive Care, University “La Sapienza” of Rome, Italy

    M. Antonelli, M. Bufi, R. A. De Blasi, G. Vivino, G. Conti, P. Pelaia & A. Gasparetto

  2. Department of Experimental Medicine, University “La Sapienza” of Rome, Italy

    L. Lenti, A. Zicari & G. Pontieri

Authors
  1. M. Antonelli
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  2. L. Lenti
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  3. M. Bufi
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  4. R. A. De Blasi
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  5. G. Vivino
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  6. G. Conti
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  7. P. Pelaia
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  8. A. Zicari
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  9. G. Pontieri
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  10. A. Gasparetto
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Additional information

The data from this study have been partially presented, as communication, during the 4th European Congress on Intensive Care Medicine in Baveno, June 14–18, 1988.

This work is partially supported by MPI 601 CAP 02112.01.04 1984/1989.

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Antonelli, M., Lenti, L., Bufi, M. et al. Differential evaluation of bronchoalveolar lavage cells and leukotrienes in unilateral acture lung injury and ARDS patients. Intensive Care Med 15, 439–445 (1989). https://doi.org/10.1007/BF00255599

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  • DOI: https://doi.org/10.1007/BF00255599

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