Increased pulmonary capillary permeability and extravascular lung water after major vascular surgery: effect on radiography and ventilatory variables.
BACKGROUND
We decided to investigate the pathogenesis of pulmonary ventilatory and radiographic abnormalities in patients after major vascular surgery.


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, (67)Ga-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 < or =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.


CONCLUSIONS
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.
Groeneveld
A B J
AB
Vrije Universiteit Medical Centre, Institute for Cardiovascular Research, Department of Intensive Care, Amsterdam, The Netherlands. johan.groeneveld@vumc.nl
Verheij
J
J
van den Berg
F G
FG
Wisselink
W
W
Rauwerda
J A
JA
D000368:Aged; D002199:Capillary Permeability / Q000502:physiology*; D004395:Dye Dilution Technique; D015633:Extravascular Lung Water / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011184:Postoperative Period; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000502:physiology*; D014656:Vascular Surgical Procedures