Cytokine, complement, and endotoxin profiles associated with the development of the adult respiratory distress syndrome after severe injury

Donnelly, Thomas; Meade, Peter; Jagels, Mark A.; Cryer, H. Gill; Law, Michael M.; Hugli, Tony E.; Shoemaker, William C.; Abraham, Edward

doi:10.1097/00003246-199405000-00010

Cited by 155 publications

(95 citation statements)

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“…Severe tissue trauma, major surgery and esophageal resection in particular are pathophysiological mechanisms that may result in an excessive uncontrolled activation of inflammatory cells and mediators. This inflammatory response may play a key role in the development of cell and organ disfunction, which is the basis of ALI and ARDS (6)(7)(8). Cytokines involved in the early phase of inflammatory response include IL1, IL2, IL6 and IL8 (27)(28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

“…A wide variety of clinical conditions such as sepsis, burns, trauma and major surgery and esophageal resection in particular, constitute a predisposition for the development of ARDS (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…ALI or ARDS (4,6,25) and plasma cytokine levels are known to correlate with postoperative morbidity and mortality rates (12,13). To address this issue, we investigated the impact of the thoracic approach in thoracoabdominal esophagectomy on plasma cytokine levels.…”

Section: Introductionmentioning

confidence: 99%

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Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Frick

Justinger²,

Rubie³

et al. 2011

Oncol Rep

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Abstract. Pulmonary complications together with surgical complications are the most frequent causes for morbidity and mortality after thoracoabdominal esophagectomy. The con tinuous improvement of surgical techniques has led to a decrease in surgical complications, whereas up to 30% of the patients develop postoperative pulmonary complications such as acute lung injury (ALI) or even the more severe acute respiratory distress syndrome (ARDS), which are characterized by an acute inflammation in the lung parenchyma and the airspace. Evidence from several studies indicates that a complex network of inflammatory cytokines and mediators play a key role in mediation, amplification, and perpetuation of the process of lung injury and that the thoracotomy itself is a risk factor for developing ALI or ARDS. In this trial, the cytokine levels of IL6, IL8 and IL10 were measured and compared in 30 patients who had undergone an extended radical thoracoabdominal esophagectomy for esophageal cancer, via anterolateral thoracotomy (n=17) or posterolateral thoracotomy (n=13). Patients of both groups were similar in terms of age, sex and preoperative pulmonary function as well as in the anesthetic procedures they have undergone. All patients displayed significantly increased serum levels of IL6 and IL8 after thoracoabdominal esophagectomy. However, patients who were subjected to an anterolateral thoracotomy were reported with significantly higher serum levels of IL6 and IL8 compared to patients who had received a posterolateral thoracotomy. Thus, the choice of the thoracotomy method during the thoracoabdominal esophagectomy and the resultant cytokine levels may contribute to the occurrence of postoperative pulmonary complications and may have an impact on the extent and severity of the surgical stress.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Frick

Justinger²,

Rubie³

et al. 2011

Oncol Rep

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“…1998; 80: 36-40) Keywords: lung adult respiratory distress syndrome; complications, adult respiratory distress syndrome; surgery, gastrointestinal; hormones, thromboxane; hormones, leukotrienes Adult respiratory distress syndrome (ARDS) is one of the primary contributors to mortality in ICU patients. 1 A wide variety of clinical conditions such as sepsis, burns, trauma [2][3][4] and major surgery, and oesophageal resections in particular, 5 6 predispose to the development of ARDS. In a meta-analysis of more than 60 000 patients undergoing oesophagectomy, 27% developed ARDS after transthoracic resection and 13% after transhiatal resection.…”

Section: Discussionmentioning

confidence: 99%

Role of thromboxane and leukotriene B4 in patients with acute respiratory distress syndrome after oesophagectomy

Schilling

Gassmann

Sigurdsson

et al. 1998

British Journal of Anaesthesia

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SummaryWe have studied prospectively the clinical course and serum concentrations of thromboxane B 2 (TxB 2 ) and leukotriene B 4 (LTB 4 ) in patients developing adult respiratory distress syndrome (ARDS) after oesophagectomy. The clinical course was assessed according to a validated ARDS score, and intra-and postoperative measurements of TxB 2 and LTB 4 in pre-and post-pulmonary blood were performed in 18 patients undergoing oesophagectomy for oesophageal carcinoma and 11 control patients undergoing thoracotomy and pulmonary resection. Six of 18 patients undergoing oesophagectomy, but no control patient, developed ARDS. The ARDS score was highest on day 8 after operation. Only patients with ARDS had a significant postoperative increase in postpulmonary, but not pre-pulmonary, TxB 2 concentrations (P : 0.05 vs patients without ARDS).This study provides evidence that TxA 2 , originating from the lungs, was associated with the development of ARDS after oesophageal resection. In view of the high incidence of ARDS after oesophagectomy (10-30%), prophylactic treatment of patients undergoing oesophageal resection with clinically applicable thromboxane synthetase inhibitors may be warranted. (Br. J. Anaesth. 1998; 80: 36-40) Keywords: lung adult respiratory distress syndrome; complications, adult respiratory distress syndrome; surgery, gastrointestinal; hormones, thromboxane; hormones, leukotrienes Adult respiratory distress syndrome (ARDS) is one of the primary contributors to mortality in ICU patients. 1 A wide variety of clinical conditions such as sepsis, burns, trauma 2-4 and major surgery, and oesophageal resections in particular, 5 6 predispose to the development of ARDS. In a meta-analysis of more than 60 000 patients undergoing oesophagectomy, 27% developed ARDS after transthoracic resection and 13% after transhiatal resection. 7 The following factors appear to increase the risk of postoperative ARDS in patients with oesophageal carcinoma: smoking and chronic obstructive pulmonary disease (COPD), transthoracic mobilization of the oesophagus with contusion of the lung during extensive surgery and postoperative (silent) aspiration. 8 Because of the heterogenity of sepsis or trauma patients, it is difficult to acquire comparable study populations for clinical studies of ARDS. In these patients, the triggering insult for ARDS is seldom predictable and it varies greatly in intensity; also, patient conditions such as age, immune and nutritional status and coexisting medical conditions vary widely. Patients undergoing oesophageal resection for oesophageal carcinoma, however, are a homogenous group, with 1-3 of 10 patients developing ARDS. 7 They are usually aged 50-70 yr, the majority have a history of smoking and preoperative weight loss, they are suffering from the same underlying disease, and the duration and magnitude of the insult triggering ARDS (i.e. oesophageal resection) is uniform. In addition, these patients are unique in that they are exposed to a planned triggering factor (i.e. oesophageal resection) ...

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“…The literature pointed towards mediators, such as endotoxin, cytokines, platelet activating factors, and complement [22,23,24,25,26,27]. But several attempts could not confirm any of them in a conclusive fashion [28], especially in clinical trials. Yet, antibodies against complement 5a were effective in improving the hemodynamic complications associated with endotoxic shock [29].…”

Section: Inflammatory Mediatorsmentioning

confidence: 99%

A journey with Tony Hugli up the inflammatory cascade towards the auto-digestion hypothesis

Schmid‐Schönbein

2007

International Immunopharmacology

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My association with Tony Hugli, long-term editor of Immunopharmacology and International Immunopharmacology, came about by a specific and long-standing problem in inflammation research. What is the trigger mechanism of inflammation in physiological shock? This is an important clinical problem due to the high mortality associated with physiological shock. We joined forces in the search of the answer to this question for more than a decade. Our journey eventually led to development of the hypothesis that shock may be associated with pancreatic enzymes, a set of powerful digestive enzymes that are an integral part of human digestion. The digestive enzymes need to be compartmentalized in the lumen of the intestine where they break down a broad spectrum of biological molecules into their building blocks, suitable for molecular transport across the mucosal epithelium into the circulation. The mucosal epithelial barrier is the key element for compartmentalization of the digestive enzymes. But under conditions when the mucosal barrier is compromised, the fully activated digestive enzymes in the lumen of the intestine are transported into the wall of the intestine, starting an auto-digestion process. In the process several classes of mediators are generated that by themselves have inflammatory activity and upon entry into the central circulation generate the hallmarks of inflammation and eventually cause multi-organ failure. Thus, our journey led to a new hypothesis, which is potentially of fundamental importance for death by multi-organ failure. The auto-digestion hypothesis is in line with the century old observation that the intestine plays a special role on shock -indeed it is the organ for digestion. Auto-digestion may be the prize to pay for life-long nutrition.

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Cytokine, complement, and endotoxin profiles associated with the development of the adult respiratory distress syndrome after severe injury

Cited by 155 publications

References 0 publications

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Role of thromboxane and leukotriene B4 in patients with acute respiratory distress syndrome after oesophagectomy

A journey with Tony Hugli up the inflammatory cascade towards the auto-digestion hypothesis

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