Pulmonary endothelial permeability changes after major lung resection.
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.
Waller
D A
DA
Regional Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
Keavey
P
P
Woodfine
L
L
Dark
J H
JH
D000328:Adult; D000368:Aged; D002463:Cell Membrane Permeability; D016207:Cytokines / Q000097:blood; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000166:cytology* / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011184:Postoperative Period; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D011652:Pulmonary Circulation / Q000502:physiology; D011877:Radionuclide Imaging; D014655:Vascular Resistance
D016207:Cytokines