Infections and the inflammatory response in acute respiratory distress syndrome
Infections and the inflammatory response in acute respiratory distress syndrome
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DOI：
10.1378/chest.111.5.1306
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发表时间：
1997-05-01
期刊：
影响因子：
9.6
通讯作者：
Meduri, GU
中科院分区：
文献类型：
--
作者：
Headley, AS;Tolley, E;Meduri, GU
研究目的：全身炎症反应综合征(SIRS)和感染与急性呼吸窘迫综合征(ARDS)和多器官功能障碍综合征(MODS)的发生发展密切相关。我们研究了ARDS的发病和进展过程中，(1)SIRS的临床变量和生物标志物、(2)严格标准定义的感染和(3)患者预后之间的关系。SIRS生物学标志物包括血浆和BAL液中炎性细胞因子(IC)-肿瘤坏死因子-α(TNF-α)和白细胞介素1(IL)1、2、4、6和8的系列检测。方法：我们前瞻性地研究了两组ARDS患者：34例常规治疗的ARDS患者(组1)和9例接受糖皮质激素抢救治疗的未缓解ARDS患者(组2)，每天记录患者的个体化SIRS标准和SIRS综合评分。应用双抗体夹心酶联免疫吸附试验检测ARDS患者发病第1、2、3、5、7、10、12天及以后每隔3天的血浆IC水平。除非有禁忌证，否则双侧BAL均在第1天、每周一次以及怀疑呼吸机相关性肺炎时进行。结果：有和无脓毒症患者入院时ICU病死率相似(54%比40%；P
Study objective: Systemic inflammatory response syndrome (SIRS) and infections are frequently associated with the development and progression of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS). We investigated, at onset and during the progression of ARDS, the relationships among (1) clinical variables and biological markers of SIRS, (2) infections defined by strict criteria, and (3) patient outcome. Biological markers of SIRS included serial measurements of inflammatory cytokines (IC)-tumor necrosis factor-alpha (TNF-alpha) and interleukins (IL) 1 beta, 2, 4, 6, and 8-in plasma and BAL fluid.Methods: We prospectively studied two groups of ARDS patients: 34 patients treated conventionally (group 1) and nine patients who received glucocorticoid rescue treatment for unresolving ARDS (group 2), Individual SIRS criteria and SIRS composite score were recorded daily for all patients. Plasma IC levels mere measured by enzyme-linked immunosorbent assay on days 1, 2, 3, 5, 7, 10, and 12 of ARDS and every third day thereafter while patients received mechanical ventilation. Unless contraindicated, bilateral BAL was performed on day 1, weekly, and when ventilator-associated pneumonia was suspected. Patients were closely monitored for the development of nosocomial infections (NIs).Results: ICU mortality was similar among patients with and without sepsis on admission (54% vs 40%; p