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Pulmonary endothelial permeability changes after major lung resection.

D A Waller·P Keavey·L Woodfine·J H Dark
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Abstract

BACKGROUND: Increased pulmonary endothelial permeability has been proposed as a cause of postpneumonectomy pulmonary edema. This study investigated changes in pulmonary endothelial permeability after major lung resection. METHODS: Lung scintigraphy was performed in 21 men (median age, 66 years; range, 34 to 73 years) after pneumonectomy (10 patients) or lobectomy (11 patients). Pulmonary endothelial permeability was measured by the net pulmonary accumulation of intravenous technetium-99m-labeled albumin, calculated as a ratio of lung:heart radioactivity counts. Pulmonary hemodynamics were monitored continuously by a pulmonary artery catheter, and serum levels of inflammatory cytokines were assayed. RESULTS: The lung:heart radioactivity ratio increased significantly in the initial 8 hours after pneumonectomy but not after lobectomy (p < 0.01). Mean pulmonary artery pressure and pulmonary vascular resistance both increased significantly during pneumonectomy (p < 0.05). The intraoperative increase in mean pulmonary artery pressure was inversely related to preoperative mean pulmonary artery pressure (r = -0.47; p = 0.02). The postoperative change in lung:heart radioactivity ratio to the perioperative increase in pulmonary vascular resistance (r = 0.54; p = 0.02) but not to the increase in mean pulmonary artery pressure (r = 0.14; p > 0.05). Serum interleukin-8 and neutrophil elastase levels were elevated in all patients preoperatively. The postoperative change in lung:heart radioactivity ratio was related to preoperative elastase levels (r = 0.61; p = 0.02). CONCLUSIONS: Pulmonary endothelial permeability appears to be increased after pneumonectomy. Preoperative neutrophil activation and the adaptation of the remaining pulmonary vasculature may be etiologic factors.

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AdultAgedCell Membrane PermeabilityCytokinesHemodynamicsHumansLungLung DiseasesMaleMiddle AgedPneumonectomyPostoperative PeriodProspective StudiesPulmonary ArteryPulmonary CirculationRadionuclide ImagingVascular ResistanceJournal ArticleResearch Support, Non-U.S. Gov't

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D A Waller, P Keavey, L Woodfine, J H Dark. 1996. Pulmonary endothelial permeability changes after major lung resection.. https://doi.org/10.1016/0003-4975(96)00103-8

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