الفهرس 
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Abstract
The present study aimed at estimation of NK-B level in broncho-alveolar fluid using fiber-optic bronchoscope (FOB) in critically ill pediatric patients with ALI and evaluation of its diagnostic value.
The current study included 20 critically ill pediatric patients on mechanical ventilation, with ALI, admitted to Ain Shams PICU. It included 20 non –ALI mechanically ventilated children as control group.
Patients with past history of chronic pulmonary disorder, patients with cardiac lesion, COPD and sarciodosis were excluded from the present study. All patients underwent full clinical examination, chest AP view X-ray, laboratory investigation including; complete blood count, CRP, and arterial blood gases.
Broncho-alveolar lavage by fiber-optic bronchoscope was used to study NK-B level in BAL in ALI patients and mechanically ventilated control group (non ALI- group). NK-B was assayed in BAL by ELISA.
ALI affects males (70 %) more than females (30 %) and the difference is not significant and bronchopneumonia is the most common cause as a direct injury to the lungs (40%). Moreover NK-B level in broncho-alveolar lavage of patients was highly significant elevated (Mean = 0.58 ug/ug nuclear protein) when compared to non ALI- group(Mean = 0.034 ug/ ug nuclear protein ) and( p< 0.01 HS).
There were significant positive correlations between NKB and CRP(r= 0.35), IT(r=-0.36), passive smoking history (r= 0.4) and platelets (r=-0.36).
Moreover there is highly significant positive correlation between NK-B and PEEP (r=0.43), and crowding index (r=0.42). Also, there is significant positive correlation between NK-B and IT(r=0.36), platelets(r=0.36) and CRP(r=0.35) (p<0.05).
In the present study there is negative correlation between NK-B and age(r= 0.21), weight(r= 0.22), passive smoking history(r= 0.4), duration of MV(r=0.04), PIP(r= 0.12), PaO2(r=0.47), FIO2 (r=0.03), rate (r=0.05), Ang-1 and all studied parameters among patients.
In the current study we detected the best cut off level for NF-K B in BALF which was 0.97ug/ug nuclearprotein and was highly statistical significant to diagnose ALI among ventilated patients (ALI- group) with 95% sensitivity and 95% specificity.