TUMOR-NECROSIS-FACTOR IN SERUM AND IN BRONCHOALVEOLAR LAVAGE OF PATIENTS AT RISK FOR THE ADULT RESPIRATORY-DISTRESS SYNDROME

Tumor necrosis factor-alpha (TNF) production was analyzed in 30 mechanically ventilated patients at high risk for the adult respiratory distress syndrome (ARDS) as defined by the presence of septic syndrome or following multiple trauma. Ten patients mechanically ventilated with acute cerebral hemorrhage were studied as a control group. Serum samples were drawn on entry into the study every 30 minutes for 90 minutes (0hr), 24 hours (24hr), and 48 hours (48hr) after enrollment. Bronchoalveolar lavage (BAL) was performed on the first and third day serum and BAL fluid were essayed for TNF content. No detectable amount of TNF was observed in 10 nonseptic controls. Production of TNF did not vary over the study period and was observed not only in patients with septic syndrome but also in patients without sepsis. Tumor necrosis factor did not correlate with mortality, severity of illness, and clinical parameters. Patients developing ARDS showed a significantly higher concentration of TNF in BAL than in serum (96 ± 25 v 28 ± 27 pg/mL at 0hr; 91 ± 29 v 22 ± 25 pg/mL at 48hr; P < .05). These data support the concept of local pulmonary production of this cytokine in ARDS.