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Critical care
Pilot study
Lower airways inflammation in patients with ARDS measured using endotracheal aspirates: a pilot study
  1. Savino Spadaro1,
  2. Iryna Kozhevnikova1,
  3. Paolo Casolari2,
  4. Paolo Ruggeri3,
  5. Tiziana Bellini4,
  6. Riccardo Ragazzi1,
  7. Federica Barbieri1,
  8. Elisabetta Marangoni1,
  9. Gaetano Caramori3 and
  10. Carlo Alberto Volta1
  1. 1Unità Operativa di Anestesia e Rianimazione Universitaria dell’Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, University of Ferrara, Ferrara, Italy
  2. 2Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-Correlate (CEMICEF), Dipartimento di Scienze Mediche, Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Ferrara, Italy
  3. 3Unità Operativa Complessa di Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), Messina, Italy
  4. 4Department of Biomedical and Specialty Surgical Sciences, Medical Biochemistry, Molecular Biology and Genetics Section, University of Ferrara, Ferrara, Italy
  1. Correspondence to Dr Savino Spadaro; savinospadaro{at}gmail.com

Abstract

Introduction Our knowledge of acute respiratory distress syndrome (ARDS) pathogenesis is incomplete. The goal of this pilot study is to investigate the feasibility of measuring lower airways inflammation in patients with ARDS using repeated endotracheal aspirates (ETAs).

Methods ETAs were obtained within 24 hours by intensive care unit admission from 25 mechanically ventilated patients with ARDS and 10 of them underwent a second ETA within 96 hours after the first sampling. In each sample, cell viability was assessed using trypan blue exclusion method and the total and differential cell counts were measured using Neubauer-improved cell counting chamber and cytospins stained with Diff-Quik.

Results The median cell viability was 89 (IQR 80–93)%, with a median total cell count of 305 (IQR 130–1270)×103/mL and a median macrophage, neutrophil, lymphocyte and eosinophil count, respectively, of 19.8 (IQR 5.4–71.6)×103/mL; 279 (IQR 109–1213)×103/mL; 0 (IQR 0–0.188)×103/mL; 0 (IQR 0–1.050)×103/mL. Eosinophil count in the ETA correlated with the number of blood eosinophils (r=0.4840, p=0.0142). Cell viability and total and differential cell counts were neither significantly different in the second ETA compared with the first ETA nor were unaffected by the presence or absence of bacteria in the blood and/or ETA, or by the ARDS aetiology, apart from the macrophage count which was significantly increased in patients with ARDS associated with acute pancreatitis compared with those associated with pneumonia (p=0.0143).

Conclusions ETA can be used to investigate the cellularity of the lower airways in patients with ARDS and it is an easy-to-perform and non-invasive procedure. Eosinophil counts in ETA and blood are significantly correlated. The number of macrophages in ETA may be affected by the aetiology of the ARDS.

  • ARDS
  • lower airways inflammation
  • endotracheal aspirate
  • macrophages
  • eosinophils

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjresp-2017-000222

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    Footnotes

    • Contributors Conceived and designed the protocol: IK, SS, GC, PC, CAV. Recruited the patients: IK, SS, EM, FB, RR. Laboratory work: IK, PC, TB. Analysed the data: IK, SS, PR, CAV. Wrote the paper: all authors. Review of manuscript: all authors. All authors read and approved the final manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ethics Committee of Ferrara.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Not available