Acute lung injury after aortic surgery: the relation between lung and leg microvascular permeability to 111indium-labelled transferrin and circulating mediators.

Abstract

BACKGROUND:

Aortic surgery is a risk factor for acute lung injury and this may relate to ischaemia/reperfusion (I/R) of the lower body and release of inflammatory mediators. The aim of this study was to define the changes in microvascular protein permeability and circulating inflammatory mediators after aortic surgery.

METHODS:

In 11 consecutive patients who underwent elective aortic surgery microvascular permeability in lung and leg was measured before and a median of 2.8 hours after completion of surgery using 111indium (In)-labelled transferrin and 99mtechnetium (Tc)-labelled red blood cells, yielding a protein leak index (PLI) that is specific for protein permeability. Circulating leucocyte counts and levels of inflammatory mediators were determined.

RESULTS:

In the lung the PLI rose from a median of 0.6 (range -0.5 to 2.2) x 10(-3)/min before surgery to 5.4 (-2.3 to 33.5) x 10(-3)/min after surgery, and in the leg from 0.3 (-1.6 to 1.7) x 10(-3)/min to 5.0 (1.0 to 27.8) x 10(-3)/min. The increase in PLI in the lung was related to that in the leg. Levels of activated complement C3a and tumour necrosis factor-alpha did not change, but levels of interleukin (IL)-6, IL-8 and elastase-alpha 1-antitrypsin increased. After surgery there was slight neutrophilia and the leucocyte counts were inversely related to the IL-8 level. The rise in lung but not in leg PLI was greatest in patients with the highest IL-8 levels and the lowest leucocyte counts.

CONCLUSIONS:

Early after aortic surgery microvascular protein permeability increases in the leg and lung. Leg I/R injury may result in neutrophil activation and release of IL-8, which may induce neutrophil sequestration and subsequently increased pulmonary microvascular permeability. These findings may help to explain the occurrence of acute lung injury after I/R in man.

• Authors: P G Raijmakers, A B Groeneveld, J A Rauwerda, G J Teule, C E Hack
• Journal: Thorax (Thorax) Vol. 52 Issue 10 Pg. 866-71 (Oct 1997) ISSN: 0040-6376 [Print] England
• PMID: 9404373 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Indium Radioisotopes
• Inflammation Mediators
• Proteins
• Transferrin

Topics

• Adult
• Aged
• Aorta (surgery)
• Blood Pressure
• Capillary Permeability
• Female
• Humans
• Indium Radioisotopes
• Inflammation Mediators (blood)
• Leg (blood supply)
• Lung (blood supply)
• Male
• Middle Aged
• Postoperative Complications (physiopathology)
• Proteins (metabolism)
• Pulmonary Gas Exchange
• Radiography
• Respiratory Distress Syndrome (diagnostic imaging, etiology, physiopathology)
• Transferrin (pharmacokinetics)