J.Jpn. Surg. Soc.. 89(11): 1822-1833, 1988

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Original article

ACUTE RESPIRATORY FAILURE AFTER HEPATIC RESECTION IN CANINE BILIARY OBSTRUCTION MODEL

Acute respiratory failure after hepatic resection, especially in case of concomitant liver dysfunction, is the most troublesome postoperative complication. In order to clarify the pathophysiological mechanism of acute respiratory failure, EVLW (extravascular lung water) was measured by double indicator dilution method in canine model.
Mongrel dogs underwent laparotomy and the common bile duct was ligated and devided. After 6 weeks, EVLW was significantly elevated compared with that of normal dogs (p＜0.05). From 4 hours after 70% hepatic resection dextran-40 was loaded to increase PWP (pulmoanry wedge pressure). EVLW was increased accompanying the elecvation of PWP in all groups, but in the group with biliary obstruction EVLW was significantly increased for the same elevation of PWP. These results suggest that permeability of pulmoanry capillary was highly increased after hepatic resection in biliary obstruction group.
Pulmonary edema in this canine model seems to resemble ARDS in human and the pathophysiological mechanism was thought to be related with depression of RES phagocytic function, activation of complement system and pulmoanry vascular plagging by aggregates of degenerating granulocytes and endothelial injury.
Gabexate mesilate blocked the increase of the lung vascular permeability and was thought to be effective to protect the lung from postoperative acute respiratory failure.

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