[ARDS-like reactive respiratory failure after radical operation for esophageal cancer--with reference to PMN elastase...

In a study undertaken to elucidate the pathophysiology underlying reactive respiratory failure following surgery for esophageal cancer, postoperative esophageal cancer patients were divided into 2 groups, i.e. one with respiratory failure (defined as impairment of oxygenating capacity with a respiratory index (RI) value of 1.5 or above, lasting from more than 5 days after surgery) and the other without it, and between-group comparisons were made of respiratory & circulatory dynamics and biologic response system components, e.g., complement, anaphylatoxins and polymorphonuclear granulocytes (PMN) elastase. There were no differences between the two groups in patient's age at operation and pulmonary function test. The mean duration of endotracheal control was 5.1 days for the respiratory failure (+) group against 3.7 days for the respiratory failure (-) group. Assessments of respiratory & circulatory dynamics showed that the RI was significantly increase early in the postoperative course in the respiratory failure (+) group as compared with the respiratory failure (-) group, while the hydrostatic pressure of pulmonary circulation (pulmonary microvascular pressure (Pmv)-plasma colloid-osmotic pressure (COP] and pulmonary shunting rate (Qs/Qt) were also elevated in the former group. Among biologic response parameters, the leukocyte count, platelet count, CH5, C3, and C5 showed long-sustained decreases from the postoperative day 1 on in the repertory failure (+) group as compared to the respiratory failure (-) while PMN elastase activity and anaphylatoxin C3a were elevated from the postoperative day 1 on in the former group.(ABSTRACT TRUNCATED AT 250 WORDS)