Alterations in bronchoalveolar lavage fluid during ischemia-induced acute hepatic failure in the pig

The objective of this controlled experimental animal study was to evaluate whether acute hepatic failure (AHF) can cause acute lung injury (ALI) and to investigate possible pathophysiologic mechanisms. Seventeen domestic pigs were randomly assigned to AHF and sham groups. AHF was induced by surgical devascularization of liver in 10 animals. Seven animals were sham operated. Hemodynamics, lung mechanics, extravascular lung water (EVLW), and intracranial pressure, blood gas, liver function tests, and serum endotoxin levels were measured. Cells count, total protein, and phospholipids and phospholipases A(2) were determined in the bronchoalveolar lavage (BAL) fluid. Measurements were obtained after the insertion of central lines and 4 hours and 7 hours after the completion of the surgical procedure. Hemodynamic, biochemical, neuromonitoring, and histologic data confirmed the development of liver failure. Seven hours after devascularization, EVLW was higher in AHF (13.7 +/- 1.8 mL/kg) compared with the sham group (5.9 +/- 0.7 mL/kg) (P < .05); in AHF, increase of neutrophils (5% +/- 8% to 25% +/- 8%, P < .001), total protein (6.2 +/- 3.7 to 11.2 +/- 6.5 mug/mL, P < .048), and phospholipase A(2) (1.43 +/- 0.56 to 2.38 +/- 1.38 nmoL/mL/h, P < .03) and decrease in PAF-acetylhydrolase (0.114 +/- 0.128 to 0.039 0.038 nmol/mL/h, P < .01) compared with baseline were observed; total phospholipids decreased in AHF and increased in the sham model. Histologic examination confirmed lesions compatible with acute lung injury. In conclusion, AHF due to hepatic devascularization induced acute lung injury, confirmed by the increase of inflammatory cells in the alveoli as well as by histologic findings. The decreased PAY-AcH and the increased phospholipase A2 may play a significant role in the perpetuation of inflammation accompanied by surfactant disorders.