Cell death of alveolar lymphocytes and monocytes is negatively correlated with driving pressure and mechanical power in patients with acute respiratory distress syndrome

Shaw-Woei Leu; Chien-Min Chu; Chia-Jung Chung; Chih-Yu Huang; Chao-Hung Wang; Li-Fu Li; Huang-Pin Wu

doi:10.1186/s40001-023-01607-4

Cell death of alveolar lymphocytes and monocytes is negatively correlated with driving pressure and mechanical power in patients with acute respiratory distress syndrome

Eur J Med Res. 2024 Jan 3;29(1):16. doi: 10.1186/s40001-023-01607-4.

Authors

Shaw-Woei Leu^{1

2}, Chien-Min Chu³, Chia-Jung Chung³, Chih-Yu Huang^{2

3}, Chao-Hung Wang^{2

4}, Li-Fu Li^{2

3}, Huang-Pin Wu^{5

6}

Affiliations

¹ Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan.
² College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
³ Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung. 222, Maijin Rd., Anle Chiu, Keelung, 20401, Taiwan.
⁴ Heart Failure Research Center, Division of Cardiology, Chang Gung Memorial Hospital, Keelung, 20401, Taiwan.
⁵ College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. whanpyng@cgmh.org.tw.
⁶ Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung. 222, Maijin Rd., Anle Chiu, Keelung, 20401, Taiwan. whanpyng@cgmh.org.tw.

Abstract

Background: Pathogenesis of acute respiratory distress syndrome (ARDS) involves immune cell death and removal from the injured lungs. ARDS severity is related to lung compliance. However, the correlation between the respiratory mechanics and alveolar immune cell death in patients with ARDS remains unclear.

Methods: Twenty-four patients with respiratory failure and ARDS were enrolled in the intensive care unit between November 2019 and November 2021. Neutrophil extracellular traps (NETs) and cell death of lymphocytes and monocytes in bronchoalveolar lavage fluid were detected on days 1 and 8.

Results: Lung compliance was positively correlated with the cell death percentage of alveolar CD4/CD8 lymphocytes and monocytes on day 8 (Pearson's correlation coefficient (r) = 0.554, p = 0.005; r = 0.422, p = 0.040; r = 0.569, p = 0.004, respectively). There was no association between lung compliance and the percentage of alveolar NETs on days 1 and 8. The cell death percentages of alveolar CD4/CD8 lymphocytes and monocytes were negatively correlated with driving pressure (DP) on days 1 (r = - 0.440, p = 0.032; r = - 0.613, p = 0.001; r = -0.557, p = 0.005, respectively) and 8 (r = - 0.459, p = 0.024; r = - 0.407, p = 0.048; r = - 0.607, p = 0.002, respectively). The cell death percentages of alveolar CD4/CD8 lymphocytes and monocytes were also negatively correlated with mechanical power (MP) on days 1 (r = - 0.558, p = 0.005; r = - 0.593, p = 0.002; r = - 0.571, p = 0.004, respectively) and 8 (r = - 0.539, p = 0.007; r = - 0.338, p = 0.107; r = - 0.649, p < 0.001, respectively). The percentage of alveolar NETs on days 1 and 8 was not associated with DP or MP.

Conclusion: Patients with higher cell death rates of alveolar CD4/CD8 lymphocytes and monocytes exhibited lower DP and MP. Patients with less cell death of alveolar CD4/CD8 lymphocytes and monocytes required more DP or MP to maintain adequate ventilation.

Keywords: Acute respiratory distress syndrome; Bronchoalveolar lavage fluid cells; Cell death; Driving pressure; Lung compliance; Mechanical power.

MeSH terms

Cell Death
Humans
Lung / pathology
Lymphocytes
Monocytes*
Respiratory Distress Syndrome* / etiology

Grants and funding

CMRPG2M0341, CMRPG2N0371/Chang Gung Memorial Hospital