ROLE OF THROMBOXANE AND LEUKOTRIENE B-4 IN PATIENTS WITH ACUTE RESPIRATORY-DISTRESS SYNDROME AFTER ESOPHAGECTOMY

We have studied prospectively the clinical course and serum concentrat ions of thromboxane B-2, (TxB(2),) and leukotriene B-4, (LTB4,) in pat ients developing adult respiratory distress syndrome (ARDS) after oeso phagectomy. The clinical course was assessed according to a validated ARDS score, and intra-and postoperative measurements of TxB(2), and LT B4, in pre-and post-pulmonary blood were performed in 18 patients unde rgoing oesophagectomy for oesophageal carcinoma and 11 control patient s undergoing thoracotomy and pulmonary resection. Six of 18 patients u ndergoing oesophagectomy, but no control patient, developed ARDS. The ARDS score was highest on day 8 after operation. Only patients with AR DS had a significant postoperative increase in post-pulmonary, but not pre-pulmonary, TxB(2), concentrations (P < 0.05 vs patients without A RDS). This study provides evidence that TxA(2),, originating from the lungs, was associated with the development of ARDS after oesophageal r esection. In view of the high incidence of ARDS after oesophagectomy ( 10-30%), prophylactic treatment of patients undergoing oesophageal res ection with clinically applicable thromboxane synthetase inhibitors ma y be warranted.