[Surgical stress and acute lung injury]

There has been no scientific evidence where a single surgical stress such as hemorrhage, trauma, and major surgery causes acute lung injury as ARDS. Either infection or non-infectious inflammatory process may subsequently be required to aggravate the initial lung injury to the eventual development of ARDS. Although pathophysiology of MODS in relation to surgical stress has been widely investigated, the precise inter-relationship between oxygen radicals, cytokines, eicosanoids, lipid mediators, and DIC in the development of MODS as well as ARDS is not thoroughly understood. A clinical trial in an attempt to suppress the cytokine, ETX, and NO inhalation therapy has failed to prove their advantageous effect on mortality. Further basic study on pathophysiology in the development of ARDS subsequent to surgical stress is mandatory.