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Original Research: CRITICAL CARE MEDICINE |

Bile Acid Aspiration in Suspected Ventilator-Associated Pneumonia

Yu-Chung Wu, MD; Po-Kuei Hsu, MD; Kang-Cheng Su, MD; Lung-Yu Liu, MD; Cheng-Chien Tsai, MD; Shu-Ho Tsai, BSc; Wen-Hu Hsu, MD; Yu-Chin Lee, MD, FCCP; Diahn-Warng Perng, MD, PhD, FCCP
Author and Funding Information

From the Division of Thoracic Surgery (Drs. Wu, P.-K. Hsu, and W.-H. Hsu), Department of Surgery, and the Department of Chest Medicine (Drs. Lee and Perng), Taipei Veterans General Hospital, Taipei, Taiwan; and the School of Medicine (Drs. Wu, P.-K. Hsu, Su, Liu, C.-C. Tsai, W.-H. Hsu, Lee, and Perng, and Ms. S.-H. Tsai), and the School of Nursing (Ms. S.-H. Tsai), National Yang-Ming University, Taipei, Taiwan.

Correspondence to: Diahn-Warng Perng, MD, PhD, FCCP, School of Medicine, National Yang-Ming University, Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Rd, Taipei 11217, Taiwan; e-mail: dwperng@vghtpe.gov.tw

*These authors made equal contributions to this study.


This work was supported by research grants from Taipei Veterans General Hospital (V96C1-065).

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(1):118-124. doi:10.1378/chest.08-2668
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Aims:  The aims of this study were to measure the levels of bile acids in patients with suspected ventilator-associated pneumonia (VAP) and provide a possible pathway for neutrophilic inflammation to explain its proinflammatory effect on the airway.

Methods:  Bile acid levels were measured by spectrophotometric enzymatic assay, and liquid chromatography mass spectrometry was used to quantify the major bile acids. Alveolar cells were grown on modified air-liquid interface culture inserts, and bile acids were then employed to stimulate the cells. Reverse transcriptase polymerase chain reaction and Western blots were used to determine the involved gene expression and protein levels.

Results:  The mean (± SE) concentration of total bile acids in tracheal aspirates was 6.2 ± 2.1 and 1.1 ± 0.4 μmol/L/g sputum, respectively, for patients with and without VAP (p < 0.05). The interleukin (IL)-8 level was significantly higher in the VAP group (p < 0.05). The major bile acid, chenodeoxycholic acid, stimulated alveolar epithelial cells to increase IL-8 production at both the messenger RNA and protein level through p38 and c-Jun N-terminal kinase (JNK) activation. The selective p38 and JNK inhibitors, as well as dexamethasone, successfully inhibited IL-8 production.

Conclusion:  These data suggest that early intervention to prevent bile acid aspiration may reduce the intensity of neutrophilic inflammation in intubated and mechanically ventilated patients in the ICU.

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