Devil is in the airspace: compartmentalisation of inflammation during COVID ARDS

• Published in: Thorax Vol. 78; no. 9; pp. 848 - 849
• Main Author: Shaver, C M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Thoracic Society 01.09.2023; BMJ Publishing Group LTD
• Subjects: ARDS; Biomarkers; Chemokines; Clinical outcomes; COVID-19; Cytokines; Editorial; Illnesses; Inflammation; Ligands; Mortality; Neutrophils; Patients; Plasma; Pneumonia; Respiratory distress syndrome; Steroids; Thorax; Ventilators; COVID-19; ARDS
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2023-220325

[...]of the 13 biomarkers that were enriched in the airspace, only 2 of these (CCL-20, interleukin-10) were also increased in plasma. [...]consideration of direct airspace sampling, either by BAL or heat moisture exchanger fluid11 collection, is warranted to allow investigation of the biological compartment most relevant to lung injury. [...]the current study does not provide information on airspace inflammation during the first 7 days of illness, when dynamic changes in inflammation or other injury pathways may be occurring. [...]this cohort did not attempt to subphenotype ARDS into hypoinflammatory or hyperinflammatory endotypes12 to test if alveolar inflammation patterns differ between subgroups of patients or whether this could affect treatment responses, as has been shown in other ARDS cohorts.12–14 It will be interesting for future studies to explore whether endotyping on airspace samples would be informative.