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Byline: T. Varpula (1), V. Pettila (1), E. Rintala (2), O. Takkunen (1), V. Valtonen (3) Keywords: Key words ALI; ARDS; Pneumococcal pneumonia; Corticosteroids; Methylprednisolone; Fibroproliferation Abstract: Objective: To investigate the effect of steroid treatment in the late phase of primary acute lung injury (ALI) with special emphasis on pneumococcal pneumonia. Design: Retrospective study. Setting: Multidisciplinary intensive care unit (ICU) in a university hospital. Patients: Of 31 patients with primary ALI requiring mechanical ventilation for more than 10 days, 16 were treated with methylprednisolone and 15 served as controls. Measurements and results: Steroid and control groups were comparable regarding demographic data, APACHE II score, Multiple Organ Dysfunction Score (MODS), and PaO.sub.2/FiO.sub.2-ratio on admission to ICU. The mean start of steroid therapy was 9.7 days after establishment of respiratory failure, and values for control patients were registered on day 10. The PaO.sub.2/FiO.sub.2 ratio improved significantly within 3 days after the start of steroid therapy, and MODS and C-reactive protein decreased concurrently. No differences in mortality, in length of ICU stay, or in length of mechanical ventilation were detectable. In a subgroup analysis, for patients with Streptococcus pneumoniae pneumonia, beneficial change in physiological variables was evident. Conclusions: In patients with primary ALI, steroid therapy, started 10 days after the start of mechanical ventilation, improves gas exchange and is associated with a decrease in multiorgan dysfunction. Author Affiliation: (1) Intensive Care Unit, Department of Anesthesiology, Division of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland e-mail: tero.varpula@huch.fi Tel.: + 3 58-9-47 11 Fax: + 3 58-9-47 17 56 78, FI (2) Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland, FI (3) Division of Infectious Diseases, Department of Internal Medicine, Helsinki University Central Hospital, Finland , FI Article note: Received: 21 July 1999 Final revision received: 1 November 1999 Accepted: 15 December 1999

Byline: J. Braun (1), M. Pein (1), H. Djonlagic (1), K. Dalhoff (1) Keywords: Key words Pneumonia; Central venous neutrophils; Reactive oxygen species; Chemiluminescence; Elastase; [alpha]1-proteinase inhibitor; [alpha]2-proteinase inhibitor Abstract: Objective: In pneumonia the influx of neutrophils to the lungs is thought to be of primary importance with regard to host defence and to complications like the adult respiratory distress syndrome. We wanted to evaluate the neutrophil function in patients in acute respiratory failure who required admission to the intensive care unit. Design: We determined the luminol-enhanced chemiluminescence (CL) of neutrophils isolated both from central venous and arterial blood. In addition, the plasma-concentrations of [alpha].sub.1-proteinase inhibitor, ([alph[a].sub.1]PI), [alpha].sub.2-macroglobulin ([alph[a].sub.2]PI) and elastase-[alph[a].sub.1]PI-complex (elastase) were determined by chemiluminescence immunoassay, and the intracellular elastase content of blood neutrophils was determined using immuno activation assay. Patients: 28 Patients, 18 with acute pneumonia (group 1) and 10 with cardiac pulmonary edema (group 2). Measurements and results: In group 1, luminol enhanced CL was significantly higher than in group 2 (mean 87.7 vs 30.4x10.sup.6 counts per minute, p&lt 0.01). The production of reactive oxygen species was significantly higher in central venous than in arterial neutrophils in the patients with pneumonia (p&lt 0.03). In patients with pulmonary edema there was no such difference. The plasma concentration of elastase in group 1 was significantly higher than in group 2, that of [alph[a].sub.2]PI were significantly lower. The intracellular elastase content of neutrophils was lower in group 1 than in group 2. In group 1, there was a trend for a correlation between lower intracellular elastase content and a higher elastase plasma concentration. There were no central venous -- arterial differences with regard to leukocyte count, cell differential or protein concentration in either group. Conclusion: The central venous -- arterial differences in neutrophil production of reactive oxygen species support the concept of compartmentalization of activated neutrophils from the systemic to the pulmonary compartment. Author Affiliation: (1) Department of Medicine II, Medical University of Lubeck, Ratzeburger Allee 160, D-23538 Lubeck, Germany FAX: +49 (451) 5002938, DE Article note: Received: 15 June 1995 Accepted: 18 September 1996