As shown in Figure Figure2,2, the mean ratio of oedema fluid (obtained by s-Cath) to plasma protein in patients with ACLE (n = 9) at the time of intubation was 0.20 �� 0.19, a value significantly different from that found in patients with ALI/ARDS with a secondary (indirect) origin (n = 7; 0.81 �� 0.33; P = 0.002). Patients Ivacaftor Sigma with primary ALI/ARDS (direct pulmonary, mainly pneumonia; n = 11) had a mean ratio value of 0.32 �� 0.42 (P = 0.03 vs. secondary ALI/ARDS protein concentration ratio). The mean plasma C-reactive protein level at inclusion was 183 �� 142 mg/L in the whole ALI/ARDS group (n = 21) and 79 �� 72 mg/L in patients with ACLE (n = 9; P = 0.05; Table Table1).1). Figure Figure33 shows the median value of the absolute PMN count for all but one of the patients with ACLE (n = 8) compared with the PMN count for patients with ALI/ARDS without pneumonia (n = 10), obtained by s-Cath.

There was no statistically significant difference between groups. The patients with ACLE also showed an increased PMN count, but this was not as great as that observed in the patients with ALI/ARDS.Figure 2Protein concentration ratio in patients with ACLE (n = 9), primary (n = 11) and secondary (n = 7) ALI/ARDS. Sampling obtained by s-Cath. ACLE = acute cardiogenic lung oedema; ALI = acute lung injury; ARDS = acute respiratory distress syndrome; s-Cath …Figure 3Absolute PMN count in patients with ACLE (n = 8) and ALI/ARDS without pneumonia (n = 10). The horizontal line represents the median. The box encompasses the 25th to 75th percentiles and the error bars show the 10th to 90th percentiles.

Filled circles: …Evaluation of agreement between s-Cath and mini-BAL sampling methodsBland-Altman plots evaluating agreement between the two sampling techniques using protein content and PMN percentage as efficacy parameters are shown in Figure Figure44 and and5.5. The average difference in protein content was 12.1 g/L (n = 14 paired collections, 6 patients with ACLE and 8 patients with ALI/ARDS without thick secretions; P = 0.025; 95% confidence interval (CI) 1.73 to 22.4), indicating that the protein content detected in the same patient was significantly higher when sampled by s-Cath. The differences increase as the average protein content increases in the two methods (Figure (Figure4).4). Specifically, as the average total protein concentration in the lung increases, the s-Cath method returns more protein than does the mini-BAL method.

The average difference in the PMN percentage was 14.0% (n = 15 paired collections, 6 patients with ACLE and 9 patients with Dacomitinib ALI/ARDS without thick secretions; P = 0.16; 95% CI -6.12 to 34.05), indicating that the PMN percentage detected by the two techniques in the same patient was not significantly different. The power of this test was nevertheless only 65% with our paired sample size of 15 patients.