Changes in the inflammatory response of the lung during acute respiratory distress syndrome: prognostic indicators

Am J Respir Crit Care Med. 1996 Jul;154(1):76-81. doi: 10.1164/ajrccm.154.1.8680703.


We studied paired bronchoalveolar lavage (BAL) in patients with sepsis-associated acute respiratory distress syndrome (ARDS). Patients were evaluated at one institution and underwent bronchoscopy with BAL within 48 h of the onset of ARDS. Patients were restudied with bronchoscopy and BAL after 4 d of treatment. Fifty-eight patients were initially studied, with 44 patients having follow-up bronchoscopy after 4 d. The overall 30-d survival for the ARDS group was 60%. In the initial lavage, there was no difference in the neutrophils between the survivors and nonsurvivors (survivors: 59 [0-98]%; Median [Range]; nonsurvivors: 55 [0-92]%). The follow-up lavage demonstrated a significant drop in the neutrophils for the survivors (36 [4-89]%, p < 0.002) which was not seen for the nonsurvivors (70 [26-95]%). Initial IL-8 concentrations in the BAL fluid were not significantly different between the two groups. In the follow-up lavage, there was a significant fall for the IL-8 concentrations for the survivors but not the nonsurvivors. We conclude that neutrophil influx in ARDS may rapidly resolve within a week of the onset of ARDS. The resolution of neutrophils was associated with a good prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Bronchoalveolar Lavage Fluid / chemistry
  • Bronchoalveolar Lavage Fluid / cytology
  • Bronchoscopy
  • Female
  • Humans
  • Interleukin-8 / analysis
  • Lung / pathology*
  • Male
  • Middle Aged
  • Prognosis
  • Respiratory Distress Syndrome / complications
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / pathology*
  • Sepsis / complications
  • Survival Rate


  • Interleukin-8