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Increased pulmonary capillary permeability and extravascular lung water after major vascular surgery: effect on radiography and ventilatory variables

Published online by Cambridge University Press:  23 December 2005

A. B. J. Groeneveld
Affiliation:
Vrije Universiteit Medical Centre, Institute for Cardiovascular Research, Department of Intensive Care, Amsterdam, The Netherlands
J. Verheij
Affiliation:
Vrije Universiteit Medical Centre, Institute for Cardiovascular Research, Department of Intensive Care, Amsterdam, The Netherlands
F. G. van den Berg
Affiliation:
Vrije Universiteit Medical Centre, Institute for Cardiovascular Research, Department of Radiology, Amsterdam, The Netherlands
W. Wisselink
Affiliation:
Vrije Universiteit Medical Centre, Institute for Cardiovascular Research, Department of Vascular Surgery, Amsterdam, The Netherlands
J. A. Rauwerda
Affiliation:
Vrije Universiteit Medical Centre, Institute for Cardiovascular Research, Department of Vascular Surgery, Amsterdam, The Netherlands
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Summary

Introduction: We decided to investigate the pathogenesis of pulmonary ventilatory and radiographic abnormalities in patients after major vascular surgery. Patients and methods: Sixteen mechanically ventilated patients without heart failure were studied, within 3 h after major abdominal surgery. We measured extravascular lung water, intrathoracic, global end-diastolic and pulmonary blood volumes, 67Ga-transferrin pulmonary leak index and ventilatory and radiographic variables. The latter allowed computation of the lung injury score as a measure of lung injury. Results: The extravascular lung water was elevated (>7 mL kg−1) in 5 of 16 patients, while the pulmonary leak index was elevated in 11 patients and a supranormal extravascular lung water was associated with a high pulmonary leak index and higher extravascular lung water relative to intrathoracic blood volume or pulmonary blood volume. Patients were arbitrarily divided into those with a lung injury score >1 and ≤1, and only differed in the factors composing the score as well as in extravascular lung water divided by pulmonary blood volume. A lung injury score >1 was associated with a longer duration of mechanical ventilation. Conclusion: Our data suggest that mild, subclinical, pulmonary oedema is relatively common after major vascular surgery, mainly caused by increased pulmonary capillary permeability in the absence of overt heart failure. However, permeability oedema only partially contributes to postoperative lung injury score and need for mechanical ventilation, suggesting a major contribution by atelectasis.

Type
Original Article
Copyright
© 2006 European Society of Anaesthesiology

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References

Virgilio RW, Rice CL, Smith DE et al. Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study. Surgery 1979; 85: 129139.Google Scholar
Shires GT, Peitzman AB, Albert SA et al. Response of extravascular lung water to intraoperative fluids. Ann Surg 1983; 197: 515518.Google Scholar
Vodinh J, Bonnet F, Touboul C, Lefloch JP, Becquemin JP, Harf A. Risk factors of postoperative pulmonary complications after vascular surgery. Surgery 1989; 105: 360365.Google Scholar
Jayr C, Matthay MA, Goldstone J, Gold WM, Wiener-Kronish JP. Preoperative and intraoperative factors associated with prolonged mechanical ventilation. A study in patients following major abdominal vascular surgery. Chest 1993; 103: 12311236.Google Scholar
Gelman S. The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology 1995; 82: 10261060.Google Scholar
Volta CA, Ferri E, Marangoni E et al. Respiratory function after aortic aneurysm repair: a comparison between retroperitoneal and transperitoneal approaches. Intens Care Med 2003; 29: 12581264.Google Scholar
Adembri C, Kastamoniti E, Bertolozzi I et al. Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery. Crit Care Med 2004; 32: 11701177.Google Scholar
Iglesias JL, LaNoue JL, Rogers TE, Inman L, Turnage RTH. Physiologic basis of pulmonary edema during intestinal reperfusion. J Surg Res 1998; 80: 156163.Google Scholar
Raijmakers PGHM, Groeneveld ABJ, Rauwerda JA et al. Transient increase in interleukin-8 and pulmonary microvascular permeability following aortic surgery. Am J Respir Crit Care Med 1995; 151: 698705.Google Scholar
Raijmakers PGHM, Groeneveld ABJ, Rauwerda JA, Teule GJJ, Hack CE. Acute lung injury after aortic surgery: the relation between lung and leg microvascular permeability to 111indium-labelled transferrin and circulating mediators. Thorax 1997; 53: 866871.Google Scholar
Skillman JJ, Restall S, Salzman EW. Randomized trial of albumin vs. electrolyte solutions during abdominal aortic operations. Surgery 1975; 78: 291303.Google Scholar
Halperin BD, Feeley TW, Mihm FG, Chiles C, Guthaner DF, Blank NE. Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest 1985; 88: 649652.Google Scholar
Sibbald WJ, Short AK, Warshawski FJ, Cunningham DG, Cheung H. Thermal dye measurements of extravascular lung water in critically ill patients. Intravascular Starling forces and extravascular lung water in the adult respiratory distress syndrome. Chest 1985; 87: 585592.Google Scholar
Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia. Br J Anaesth 2003; 91: 6172.Google Scholar
Gödje O, Peyerl M, Seebauer T, Dewald O, Reichart B. Reproducibility of double indicator dilution measurement of intrathoracic blood volume compartments, extravascular lung water, and liver function. Chest 1998; 113: 10701077.Google Scholar
Boussat S, Jacques T, Levy B et al. Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema. Intens Care Med 2002; 28: 712718.Google Scholar
Honore PM, Jacquet LM, Beale RJ et al. Effects of normothermia vs. hypothermia on extravascular lung water and serum cytokines during cardiopulmonary bypass: a randomized, controlled trial. Crit Care Med 2001; 29: 19031909.Google Scholar
Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988; 138: 720723.Google Scholar