New bronchoscopic microsample probe to measure the biochemical constituents in epithelial lining fluid of patients with acute respiratory distress syndrome

Objective: A noninvasive bronchoscopic microsampling (BMS) probe was developed to sample biochemical constituents of the epithelial lining fluid in small airways. Design: Observational, controlled study. Setting: Intensive care unit of academic medical center. Patients and Procedure: EMS was applied in a control group of seven patients who had hemoptysis or small solitary peripheral nodules but no hypoxemia or other signs of acute inflammation and in four patients with acute respiratory distress syndrome (ARDS), to test whether EMS can ascertain the presence of acute pulmonary inflammation without complications, Measurements and Results: Complications, including a significant decrease in arterial oxygen saturation, were observed neither during nor after EMS. In the ARDS group, albumin, lactate dehydrogenase, interleukin-6, basic fibroblast growth factor, and neutrophil elastase concentrations in epithelial lining fluid were significantly higher (p < ,0001, p = ,012, p < .0001, p < .0001, and p < ,0001, respectively) than in the control group. Serial EMS was safely performed in one patient with ARDS, allowing us to observe a correlation between changes in the concentration of inflammation-related biochemical markers and clinical course of the disease. Conclusions:These results suggest that EMS is safe and useful to monitor pulmonary biochemical events in ARDS,