Role of the Neutrophil in Septic Shock and the Adult Respiratory Distress Syndrome

The adult respiratory distress syndrome (ARDS) is a serious complication of many medical and surgical conditions, most of which do not involve direct pulmonary injury. In surgical practice, septic shock has long been recognised as an important cause of ARDS and it presents many management challenges. Endotoxin released from dead and dying Gram-negative bacteria induces a generalised inflammatory response that results in multiple organ dysfunction, the lung being just one target of this injurious process. In recent years, with the discovery of several key inflammatory mediators, many aspects of this complex condition have been elucidated. The neutrophil has emerged as the central effector cell and possesses a formidable armamentarium of cytokines, enzymes, and oxygen radicals that are capable of inflicting damage to cells. In this review I examine the mechanisms underlying the recruitment and activation of neutrophils in ARDS.