Potential for Lung Recruitment Maneuvers Estimated by the Cytokines in Bronchoalveolar Lavage Fluid in Acute Respiratory Distress Syndrome

Overview

Journal Emerg Med Int

Publisher Wiley

Specialty Emergency Medicine

Date 2025 Feb 18

PMID 39963352

Authors

Minjin Shen

Jiaping Huai

Affiliations

Soon will be listed here.

Abstract

Lung recruitment maneuvers (RMs) is an important treatment for acute respiratory distress syndrome (ARDS) patients; however, assessing lung recruitability is imperative to avoid biotrauma and hemodynamic instability. This study aims to investigate whether the cytokine levels in the bronchoalveolar lavage fluid (BALF) of ARDS patients can serve as an indicator of their lung recruitability. This study included ARDS patients who received mechanical ventilation for over 24 h. Patients were categorized into lung recruitment maneuver effective (RM-E) group and lung recruitment maneuver noneffective (RM-N) group. Interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-10 (IL-10) in BALF, lung ultrasound (LUS) scores, and the oxygenation index (P/F) were measured. The differences in cytokine levels between the two groups were compared, and correlations between changes in cytokine levels (ΔIL-6, ΔIL-8, and ΔIL-10), ΔLUS, and ΔP/F were analyzed. Sixty-two patients were included in this study (38 in the RM-E group and 24 in the RM-N group). After the RM, compared with the RM-N group, an increase was observed in ΔIL-6 (=0.013), ΔIL-8 (=0.045), ΔIL-10 (=0.039), and ΔLUS (=0.045) in the RM-E group. A positive linear correlation was found between ΔIL-6 and ΔLUS ( = 0.504, < 0.001). The area under the lung recruitment potential curve (AUC) predicted by ΔIL-6 was 0.794, the sensitivity was 94.7%, and the specificity was 70.8%. A positive linear correlation was found between ΔIL-6 and ΔLUS ( = 0.504, < 0.001). The lung recruitment potential curve's AUC predicted by ΔIL-6 was 0.794, with a sensitivity of 94.7% and specificity of 70.8%. Lower levels of cytokines in BALF were observed in the RM-E group. It is possible that the cytokines in BALF, especially IL-6, could be used to determine the need for RM on the basis of lung recruitability.

References

Miranda D, Gommers D, Struijs A, Dekker R, Mekel J, Feelders R . Ventilation according to the open lung concept attenuates pulmonary inflammatory response in cardiac surgery. Eur J Cardiothorac Surg. 2005; 28(6):889-95. DOI: 10.1016/j.ejcts.2005.10.007. View

Brower R, Matthay M, Morris A, Schoenfeld D, Thompson B, Wheeler A . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342(18):1301-8. DOI: 10.1056/NEJM200005043421801. View

Li M, Han G, Li J, Xu J, Shi Z, Zhang Z . Effect of Repeated Recruitment Manoeuvres on Patients with Severe Acute Respiratory Distress Syndrome. West Indian Med J. 2015; 64(4):362-6. PMC: 4909068. DOI: 10.7727/wimj.2014.082. View

Grasso S, Mascia L, Del Turco M, Malacarne P, Giunta F, Brochard L . Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology. 2002; 96(4):795-802. DOI: 10.1097/00000542-200204000-00005. View

Reilly J, Calfee C, Christie J . Acute Respiratory Distress Syndrome Phenotypes. Semin Respir Crit Care Med. 2019; 40(1):19-30. PMC: 6657496. DOI: 10.1055/s-0039-1684049. View

Abushady N, Awad H, Kamel D, Fouda E, Ahmed N, Dawoud M . Role of lung ultrasound in the assessment of recruitment maneuvers in ventilated preterm neonates with respiratory distress syndrome and its correlation with tracheal IL-6 levels: A randomized controlled trial. J Neonatal Perinatal Med. 2020; 14(3):369-374. DOI: 10.3233/NPM-200605. View

Ishizaka A, Watanabe M, Yamashita T, Ogawa Y, Koh H, Hasegawa N . New bronchoscopic microsample probe to measure the biochemical constituents in epithelial lining fluid of patients with acute respiratory distress syndrome. Crit Care Med. 2001; 29(4):896-8. DOI: 10.1097/00003246-200104000-00043. View

Bhatia M, Moochhala S . Role of inflammatory mediators in the pathophysiology of acute respiratory distress syndrome. J Pathol. 2004; 202(2):145-56. DOI: 10.1002/path.1491. View

Stuber F, Wrigge H, Schroeder S, Wetegrove S, Zinserling J, Hoeft A . Kinetic and reversibility of mechanical ventilation-associated pulmonary and systemic inflammatory response in patients with acute lung injury. Intensive Care Med. 2002; 28(7):834-41. DOI: 10.1007/s00134-002-1321-7. View

10.

Wakabayashi K, Wilson M, Tatham K, ODea K, Takata M . Volutrauma, but not atelectrauma, induces systemic cytokine production by lung-marginated monocytes. Crit Care Med. 2013; 42(1):e49-57. DOI: 10.1097/CCM.0b013e31829a822a. View

11.

Kang S, Tanaka T, Inoue H, Ono C, Hashimoto S, Kioi Y . IL-6 trans-signaling induces plasminogen activator inhibitor-1 from vascular endothelial cells in cytokine release syndrome. Proc Natl Acad Sci U S A. 2020; 117(36):22351-22356. PMC: 7486751. DOI: 10.1073/pnas.2010229117. View

12.

Chiumello D, Mongodi S, Algieri I, Vergani G, Orlando A, Via G . Assessment of Lung Aeration and Recruitment by CT Scan and Ultrasound in Acute Respiratory Distress Syndrome Patients. Crit Care Med. 2018; 46(11):1761-1768. DOI: 10.1097/CCM.0000000000003340. View

13.

Bouhemad B, Zhang M, Lu Q, Rouby J . Clinical review: Bedside lung ultrasound in critical care practice. Crit Care. 2007; 11(1):205. PMC: 2151891. DOI: 10.1186/cc5668. View

14.

Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby J . Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2010; 183(3):341-7. DOI: 10.1164/rccm.201003-0369OC. View

15.

Borges J, Okamoto V, Matos G, Caramez M, Arantes P, Barros F . Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006; 174(3):268-78. DOI: 10.1164/rccm.200506-976OC. View

16.

Dreyfuss D, Ricard J, Saumon G . On the physiologic and clinical relevance of lung-borne cytokines during ventilator-induced lung injury. Am J Respir Crit Care Med. 2003; 167(11):1467-71. DOI: 10.1164/rccm.200206-611CP. View

17.

Cherian S, Kumar A, Akasapu K, Ashton R, Aparnath M, Malhotra A . Salvage therapies for refractory hypoxemia in ARDS. Respir Med. 2018; 141:150-158. PMC: 6186150. DOI: 10.1016/j.rmed.2018.06.030. View

18.

Verbrugge S, Uhlig S, Neggers S, Martin C, Held H, Haitsma J . Different ventilation strategies affect lung function but do not increase tumor necrosis factor-alpha and prostacyclin production in lavaged rat lungs in vivo. Anesthesiology. 1999; 91(6):1834-43. DOI: 10.1097/00000542-199912000-00038. View

19.

Pinhu L, Whitehead T, Evans T, Griffiths M . Ventilator-associated lung injury. Lancet. 2003; 361(9354):332-40. DOI: 10.1016/S0140-6736(03)12329-X. View

20.

Briel M, Meade M, Mercat A, Brower R, Talmor D, Walter S . Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010; 303(9):865-73. DOI: 10.1001/jama.2010.218. View