Compartmentalisation of cytokines and cytokine inhibitors in ventilator-associated pneumonia

• Published in: Intensive care medicine 2004, Vol.30 (1), p.68-74
• Main Authors: MILLO, Julian L, SCHULTZ, Marcus J, WILLIAMS, Conrad, WEVERLING, Gerrit J, RINGROSE, Timothy, MACKINLAY, Carolyn I, VAN DER POLL, Tom, GARRARD, Christopher S
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD - analysis; Antigens, CD - blood; Bacterial pneumonia; Biological and medical sciences; Body Fluid Compartments; Bronchoalveolar Lavage Fluid - cytology; Care and treatment; Case-Control Studies; Catheters; Cytokines; Cytokines - analysis; Cytokines - antagonists & inhibitors; Cytokines - blood; Cytokines - immunology; England; Enzyme-Linked Immunosorbent Assay; Female; Hospitals; Hospitals, University; Humans; Intensive care; Intensive care medicine; Interleukin 1 Receptor Antagonist Protein; Interleukin-1 - analysis; Interleukin-1 - blood; Interleukin-10 - analysis; Interleukin-10 - blood; Interleukin-6 - analysis; Interleukin-6 - blood; Lavage; Linear Models; Male; Medical sciences; Middle Aged; Plasma; Pneumonia; Pneumonia, Bacterial - blood; Pneumonia, Bacterial - etiology; Pneumonia, Bacterial - immunology; Receptors, Interleukin-1 - analysis; Receptors, Interleukin-1 - blood; Receptors, Interleukin-1 Type I; Receptors, Tumor Necrosis Factor - analysis; Receptors, Tumor Necrosis Factor - blood; Receptors, Tumor Necrosis Factor, Type I; Respiration, Artificial - adverse effects; Risk factors; Sialoglycoproteins - analysis; Sialoglycoproteins - blood; Time Factors; Tumor Necrosis Factor-alpha - analysis; Tumor Necrosis Factor-alpha - metabolism; Tumor necrosis factor-TNF; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-003-2060-0

To examine whether cytokine concentrations change in the pulmonary compartment during the development of ventilator-associated pneumonia (VAP). 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) alpha, interleukin (IL)-1alpha, IL-1beta, IL-6, and IL-10 and the cytokine inhibitors soluble TNFalpha receptor type I (sTNFalphaRI), 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. An adult medical and surgical university hospital intensive care unit. Nine patients who developed VAP and nineteen patients who did not develop VAP served as controls. None. 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 TNFalpha, sTNFalphaRI, IL-1alpha, and IL-1beta increased significantly (P=0.002, P=0.03, P=0.04 and P=0.02, respectively). Furthermore, NBL fluid/plasma concentration ratios for TNFalpha, sTNFalphaRI, IL-1alpha, 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). 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.