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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Medl. Sep 11, 2019; 8(5): 59-71
Published online Sep 11, 2019. doi: 10.5492/wjccm.v8.i5.59
Diagnosis and treatment of acute pulmonary inflammation in critically ill patients: The role of inflammatory biomarkers
Sarah Chalmers, Ali Khawaja, Patrick M Wieruszewski, Ognjen Gajic, Yewande Odeyemi
Sarah Chalmers, Ali Khawaja, Patrick M Wieruszewski, Ognjen Gajic, Yewande Odeyemi, Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, MN 55905, United States
Sarah Chalmers, Ali Khawaja, Ognjen Gajic, Yewande Odeyemi, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Patrick M Wieruszewski, Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Chalmers S, Khawaja A, Wieruszewski PM, Ognjen G, and Odeyemi Y, contributed to writing of the manuscript, provided intellectual contributions
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sarah Chalmers, MD, Fellow, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. chalmers.sarah@mayo.edu
Telephone: +1-507-2663958 Fax: +1-507-2664372
Received: May 2, 2019
Peer-review started: May 5, 2019
First decision: June 6, 2019
Revised: July 2, 2019
Accepted: August 6, 2019
Article in press: August 7, 2019
Published online: September 11, 2019
Abstract

Pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit with a significant impact on morbidity, mortality and health care utilization despite early antimicrobial therapy and lung protective mechanical ventilation. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury. Adjunct anti-inflammatory treatment with corticosteroids is increasingly used, although the evidence for benefit is limited. The treatment decisions are based on radiographic, clinical and physiological variables without regards to inflammatory state. Current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyper-inflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications. Although many inflammatory biomarkers have been studied the most common and of interest are C-reactive protein, procalcitonin, and pro-inflammatory cytokines including interleukin 6. While extensively studied as prognostic tools (prognostic enrichment), limited data are available for the role of biomarkers in determining appropriate initiation, timing and dosing of adjunct anti-inflammatory treatment (predictive enrichment)

Keywords: Acute pulmonary inflammation, Inflammatory biomarkers, Acute respiratory distress syndrome, Pneumonia, Critical illness, Diagnosis, Treatment

Core tip: Community acquired pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury and current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyper-inflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications.