Ventilator-associated pneumonia and atelectasis: evaluation through bronchoalveolar lavage fluid analysis
Φόρτωση...
Ημερομηνία
Συγγραφείς
Nakos, G.
Tsangaris, H.
Liokatis, S.
Kitsiouli, E.
Lekka, M. E.
Τίτλος Εφημερίδας
Περιοδικό ISSN
Τίτλος τόμου
Εκδότης
Springer Verlag (Germany)
Περίληψη
Τύπος
Είδος δημοσίευσης σε συνέδριο
Είδος περιοδικού
peer reviewed
Είδος εκπαιδευτικού υλικού
Όνομα συνεδρίου
Όνομα περιοδικού
Intensive Care Med
Όνομα βιβλίου
Σειρά βιβλίου
Έκδοση βιβλίου
Συμπληρωματικός/δευτερεύων τίτλος
Περιγραφή
Objective: Surfactant offers protection against alveolar collapse and contributes to the local defense mechanism, but it is unclear if surfactant alterations have a role in the development of atelectasis or ventilator-associated pneumonia (VAP). The present study was undertaken to monitor surfactant, as well as biochemical BAL fluid alterations, during the course of VAP and atelectasis in mechanically ventilated patients without primary cardiopulmonary disease, to elucidate the pathogenesis and to differentiate these two entities. Design: Prospective controlled study. Setting: 14-bed general ICU of a 750-bed University Hospital. Patients: Sixty-one ventilated patients, without primary cardiopulmonary disease-normal initial chest X-ray, satisfactory oxygenation (PaO2/FiO(2)>300 mmHg), and expected time of ventilation exceeding 2 weeks-were initially enrolled. Twelve of them developed VAP and eight lobar or segmental atelectasis during the 2-week study period. Interventions: An initial BAL was performed in all patients within 48 h from admission. Patients who developed VAP or atelectasis were subjected to a second and third BAL during and after the resolution of VAP or atelectasis, respectively. Measurements and results: VAP and atelectasis resulted in a significant increase of total protein and markers of inflammation, such as PAF and neutrophils, which partially remitted after their resolution. Large surfactant aggregates, which contribute to surface tension decrease, were significantly reduced during both entities and remained low even after their resolution. Conclusions: BAL alterations during VAP and atelectasis suggest increased alveolar-capillary permeability, severe surfactant abnormalities, and signs of local inflammatory reaction. These alterations are associated with the observed deteriorated gas exchange and lung mechanics and could predispose to further lung injury in ventilated patients.
Περιγραφή
Λέξεις-κλειδιά
ventilator-associated pneumonia, atelectasis, bal, lung surfactant, platelet-activating factor (paf), paf-acetylhydrolase, respiratory-distress syndrome, nosocomial pneumonia, antimicrobial therapy, pulmonary-edema, mortality, etiology, resolution, infection, diagnosis, patient
Θεματική κατηγορία
Παραπομπή
Σύνδεσμος
<Go to ISI>://000182759600009
http://www.springerlink.com/content/58enna42dnwk853x/fulltext.pdf
http://www.springerlink.com/content/58enna42dnwk853x/fulltext.pdf
Γλώσσα
en
Εκδίδον τμήμα/τομέας
Όνομα επιβλέποντος
Εξεταστική επιτροπή
Γενική Περιγραφή / Σχόλια
Ίδρυμα και Σχολή/Τμήμα του υποβάλλοντος
Πανεπιστήμιο Ιωαννίνων. Σχολή Θετικών Επιστημών. Τμήμα Χημείας