Adult Respiratory Distress Syndrome in Patients with Severe Neutropenia

作者：Frederick P. Ognibene, Sue Ellen Martin, Margaret M. Parker, Terri Schlesinger, Patricia Roach, Cynthia Burch, James H. Shelhamer, Joseph E. Parrillo · 发表于：New England Journal of Medicine · 年份：1986 · DOI：10.1056/nejm198608283150904 · 被引用次数：386 · 研究领域：Sepsis Diagnosis and Treatment、Neutropenia and Cancer Infections、Adrenal Hormones and Disorders

Most investigators believe that the pulmonary endothelial damage that is characteristic of the adult respiratory distress syndrome (ARDS) requires the action of neutrophils. In a retrospective review of patients with ARDS, we looked for cases that had developed in patients who already had neutropenia. Four clinical criteria were required for the diagnosis of ARDS: the occurrence of a precipitating event, diffuse bilateral pulmonary infiltrates on a chest x-ray film, a normal intravascular volume (as reflected by a wedge pressure of less than 18 mm Hg), and arterial hypoxemia. During 2 1/2 years, 11 patients fulfilled these clinical criteria, had severe neutropenia that antedated the onset of ARDS, and had pulmonary histologic specimens obtained during the early stages (less than seven days) of clinical respiratory distress. Five of these specimens showed diffuse alveolar damage without evidence of infectious pneumonitis (the histopathological finding characteristic of ARDS), and none had a neutrophil infiltrate. We conclude that ARDS can occur in the setting of severe neutropenia, without pulmonary neutrophil infiltration.