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

We have studied prospectively the clinical course and serum concentrations of thromboxane B₂ (TxB₂) and leukotriene B₄ (LTB₄) 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 TxB₂ and LTB₄ 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 post-pulmonary, but not pre-pulmonary, TxB₂ concentrations (P < 0.05 vs patients without ARDS). This study provides evidence that TxA₂, 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.