Dysregulated alveolar function and complications in smokers following oesophagectomy.

Lugg, Sebastian T and Alridge, Kerrie A and Howells, Phillip A and Parekh, Dhruv and Scott, Aaron and Mahida, Rahul Y and Park, Daniel and Tucker, Olga Noreen and Gao, Fang and Perkins, Gavin D and Thickett, David R and Dancer, Rachel C A (2019) Dysregulated alveolar function and complications in smokers following oesophagectomy. ERJ open research, 5 (1). ISSN 2312-0541.


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Official URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC63979...


Acute respiratory distress syndrome (ARDS) has a significant impact on post-operative morbidity and mortality following oesophagectomy. Smoking is a risk factor for the development of ARDS, although the mechanism is unclear. We examined the effect of smoking on alveolar and systemic inflammation, in addition to alveolar-capillary permeability, leading to ARDS in patients undergoing oesophagectomy. We compared clinical, biomarker and PiCCO system data between current smokers (n=14) and ex-smokers (n=36) enrolled into a translational substudy of the BALTI-P (Beta Agonist Lung Injury Trial Prevention) trial. Current smokers compared with ex-smokers had significantly higher numbers of circulating neutrophils, elevated bronchoalveolar lavage (BAL) interleukin (IL)-1 receptor antagonist (IL-1ra), soluble tumour necrosis factor receptor-1 and pre-operative plasma soluble intercellular adhesion molecule-1, and lower BAL vascular endothelial growth factor and post-operative plasma IL-17 (p<0.05). On post-operative day 1, current smokers had higher extravascular lung water index (9.80 7.90; p=0.026) and pulmonary vascular permeability index (2.09 1.70; p=0.013). Current smokers were more likely to develop ARDS (57% 25%; p=0.031) and had a significantly reduced post-operative median survival (421 771 days; p=0.023). Smoking prior to oesophagectomy is associated with dysregulated inflammation, with higher concentrations of inflammatory mediators and lower concentrations of protective mediators. This translates into a higher post-operative inflammatory alveolar oedema, greater risk of ARDS and poorer long-term survival.

Item Type: Article
Subjects: WF Respiratory system. Respiratory medicine
Divisions: Planned IP Care > Respiratory Medicine
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Depositing User: Mr Philip O'Reilly
Date Deposited: 19 Mar 2019 15:56
Last Modified: 19 Mar 2019 15:56
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1950

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