Increased Thromboxane B<sub>2</sub> and Prostaglandin E<sub>2</sub> Levels Precede Clinical Acute Respiratory Distress Syndrome after Esophageal Resection

Abstract

The acute respiratory distress syndrome (ARDS) is a frequent, nonsurgical complication after esophageal resection, and requires immediate counter measures. We recently described the time course of ARDS after esophageal resection as being clinically very consistent, with a peak of pulmonary edema on postoperative day 5. In the present study, we investigated the time course of ARDS mediators such as thromboxane B2 (TxB2), prostaglandin E2 (PGE2) and endotoxin in the central venous and arterial blood of patients who had undergone esophagectomy and subsequently developed ARDS. Serum PGE2 levels in control patients were 3.2 ± 5.9 ng/ml, and 10.5 ± 6.3 ng/ml in patients who developed ARDS, with a trend towards higher PGE2 levels in ARDS patients early postoperatively. TxB2 levels ranged between 0.9 and 1.4 ng/ml in ARDS as well as control patients during the intraoperative course and the first 2 postoperative days, with a trend towards higher peripheral TxB2 levels in ARDS patients. This study provides evidence that PGE2 and TxB2 start to increase in parallel with the rise in pulmonary effusions seen on the chest X rays of patients who develop the clinical picture of ARDS.