Neutrophil oxidative burst activation and the pattern of respiratory physiologic abnormalities in the fulminant post-traumatic adult respiratory distress syndrome

A. I. Rivkind, J. H. Siegel, M. Littleton, A. De Gaetano, T. Mamantov, F. Laghi, J. C. Stoklosa

Research output: Contribution to journalArticlepeer-review

Abstract

The role of neutrophil oxidative burst activation (OBA) in the development of fulminant post-trauma adult respiratory distress syndrome (ARDS) was studied in 30 patients. Neutrophil (PMN) chemiluminescence (LE) was used as the index of OBA. Serially, for 8 days post-trauma, patient neutrophils (Pc) were studied in their own serum (Ps), normal serum (Ns), or Gey's solution (G). Ps was checked against normal neutrophils (Nc) for inhibition. LE was initiated by the addition of preopsonized zymosan to 1 x 106 PMN, the LE response monitored by luminometer, and the peak of the integral of LE recorded. Seven patients developed ARDS within the first 4 days; 12 patients developed sepsis (TS) but no ARDS, and 11 patients had uncomplicated trauma (TR). All ARDS showed increased LE (P<0.0001), at 48-96 hr. Patients without ARDS showed no significant increase in LE, although their mean injury severity (ISS) was the same. The ARDS LE response was mediated by activation of Pc [74%] with only a small but significant additional effect (6%) by ARDS serum (Ps): LE = 0.672 (Pc) + 0.24 [ARDS(Ps)] + 1343; N = 146, r2 0.733, P<0.0001. However, sera (Ps or Ns) was required, as incubation in G inhibited LE; [cells + s] > [cells + G], P<0.0001. LE is a biologic marker of ARDS, and the delay between injury and the LE indicated that initiation of ARDS may have therapeutic importance. Neutrophil activation in ARDS requires sera, but the ARDS effect appears mainly due to cells with only a small ARDS-specific serum-mediated role. The physiologic response to ARDS was evaluated by serial 8-hr studies of blood gases and pH; the respiratory index (RI) to pulmonary shunt (QS/QT) relationship, compliance (COMPL), and net fluid balance (DFLUID) PMN and platelet (PLAT) counts were also measured. Compared with TR and TS, the ARDS patients at 48-96 hr, showed increased RI, QS/QT, and DFluid requiring increased F|O2 and PEEP as COMPL and PLAT fell and LE rose. These changes were all simultaneously significant (P<0.05 to P<0.0001) by Bonferroni t-statistic applied to ANOVA. The clinical importance of these physiologic and biochemical responses was emphasized by the significantly (P<0.005) increased mortality in the ARDS patients. These data suggest that PMN LE and simple measures of respiratory function are early biologic markers of the development of fulminant post-traumatic ARDS and can be used to predict ARDS severity.

Original languageEnglish (US)
Pages (from-to)48-62
Number of pages15
JournalCirculatory Shock
Volume33
Issue number1
StatePublished - Jan 1 1991

Keywords

  • neutrophil chemiluminescence
  • neutrophil oxidative burst activation
  • neutrophil superoxide-hydroxyl radicals
  • post-trauma adult respiratory distress syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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