PULMONARY FAILURE FOLLOWING LOWER TORSO ISCHEMIA - CLINICAL-EVIDENCE FOR A REMOTE EFFECT OF REPERFUSION INJURY

Acute lung injury as a remote sequela of severe lower torso ischemia-r eperfusion has been demonstrated experimentally, in a process involvin g leukosequestration and generation of the arachidonate derivatives th romboxane and leukotriene B-4. However, contemporary clinical reports have been limited to development of transient, subclinical ''reperfusi on pulmonary edema'' several hours after declamping in patients underg oing elective abdominal aortic aneurysm repair. This report refocuses attention on the clinical syndrome of severe, acute deterioration in p ulmonary function occurring several hours after restoration of perfusi on to an ischemic lower torso in two patients. The lung injury is char acterized by progressive hypoxemia, pulmonary hypertension, decreased lung compliance, and non-hydrostatic pulmonary edema, consistent with adult respiratory distress syndrome (ARDS). This report reinforces the concept that humoral mediators generated at reflow may induce end-org an injury at a site remote from the focus of ischemia-reperfusion, and that the lung is a target organ.