Chest
Clinical Investigations in Critical Care
Deficiency of Alveolar Fluid Glutathione in Patients with Sepsis and the Adult Respiratory Distress Syndrome
Section snippets
Subjects and Protocol
Young, healthy nonsmoking volunteers were recruited from the campus of Ohio State University. All of the subjects had normal findings on history, physical examination, chest roentgenogram, and forced expiratory spirometry. The subjects were not receiving any medications or drugs. There were six male and four female subjects, with an average age of 25 ± 2 years.
Ten patients with ARDS were recruited from the medical intensive care unit at Ohio State University Hospital. There were seven women and
Clinical Correlations
There was no correlation between BAL fluid concentrations or ELF concentrations of GSH and the lung injury score, the percentage of BAL neutrophils, or the BAL total protein. In addition, there was no correlation between the percentage of BAL neutrophils and the lung injury score. Two correlations approached but did not reach statistical significance. As total protein increased, the percentage of BAL neutrophils also increased in a linear fashion (p = 0.06; data not shown). In addition, as
Discussion
The ARDS remains a formidable and potentially catastrophic clinical problem with an estimated 150,000 cases per year and mortality in excess of 50 percent.33 Despite major improvements in the ability to care for these patients over the past 10 to 15 years (mechanical ventilators, pulmonary artery catheters, PEEP, and others), mortality has remained essentially unchanged. Thus, it seems probable that further improvement in mortality will only come through advances in the understanding of the
REFERENCES (43)
Mechanisms of lung injury.
Clin Chest Med
(1982)- et al.
Oxidant activity in expired breath of patients with adult respiratory distress syndrome.
Lancet
(1986) - et al.
Increased hydrogen peroxide in the expired breath of patients with acute hypoxemic respiratory failure.
Chest
(1989) - et al.
The glutathione status of cells.
Int Rev Cytol
(1978) - et al.
Systemic glutathione deficiency in symptom-free HIV-seropositive individuals.
Lancet
(1989) - et al.
Mechanisms for the oxidation of reduced glutathione by stimulated granulocytes.
Blood
(1984) - et al.
High-performance liquid chromatography analysis of nanomole levels of glutathione, glutathione disulfide, and related thiols and disulfides.
Anal Biochem
(1980) - et al.
Adult respiratory distress syndrome: changing concepts of lung injury and repair.
N Engl J Med
(1982) - et al.
Neutrophils and the adult respiratory distress syndrome.
Am Rev Respir Dis
(1983) Neutrophils, oxygen radicals, and the adult respiratory distress syndrome.
Pulmonary strategies of antioxidant defense.
Am Rev Respir Dis
Pathology of adult respiratory distress syndrome.
Lung neutrophils in the adult respiratory distress syndrome: clinical and pathophysiologic significance.
Am Rev Respir Dis
Neutrophil-mediated endothelial injury in vitro.
J Clin Invest
Granulocytes mediate acute edematous lung injury in rabbits and in isolated rabbit lungs perfused with phorbol myristate acetate: role of oxygen radicals.
Am Rev Respir Dis
Leukocytes are required for increased lung microvascular permeability after microembolization in sheep.
Circ Res
Oxygen-radical-mediated permeability edema and vasoconstriction in isolated perfused rabbit lungs.
Am Rev Respir Dis
In vivo damage of rat lungs by oxygen metabolites.
J Clin Invest
Oxidant injury of lung parenchymal cells.
J Clin Invest
Pathogenesis of the adult respiratory distress syndrome: evidence of oxidant activity in bronchoalveolar lavage fluid.
J Clin Invest
Glutathione.
Ann Rev Biochem
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Supported by grant 21571-55-00 from the American Lung Association and grant 8707 from the Bremer Foundation.