Am. J. Respir. Crit. Care Med., Vol 149, No. 4, Apr 1994, 873-880.
Eicosanoids decrease with successful extracorporeal membrane oxygenation therapy in neonatal pulmonary hypertension
EL Dobyns, JY Wescott, JM Kennaugh, MN Ross and KR Stenmark
Department of Pediatric Critical Care, University of Colorado Health Sciences Center, Webb-Waring Lung Institute, Denver 80262.
Elevated concentrations of eicosanoids have been reported in
bronchoalveolar lavage fluid (BALF) and blood of infants with persistent
pulmonary hypertension (PPHN), thereby indicating their potential role in
its pathophysiology. Extracorporeal membrane oxygenation (ECMO) has
improved the outcome in selected infants with PPHN. We hypothesized that
ECMO, by alleviating lung injury, would be associated with decreased
eicosanoid production and clinical improvement. Twenty-two newborns with
PPHN treated with either ECMO or conventional means were studied.
Concentrations of TxB2, 6-keto-PGF1 alpha, PGD2, PGE2, LTB4, and LTE4 were
serially measured in BALF. Elevated concentrations of all eicosanoids
measured were observed in all infants with PPHN at the initiation of ECMO.
Eicosanoid concentrations decreased in all infants with a good clinical
outcome after ECMO, but they remained elevated in those with a poor
outcome. In patients with less severe PPHN, not requiring ECMO, lower
concentrations of eicosanoids were observed at initiation of therapy.
Eicosanoid levels increased or did not change over the course of
conventional treatment. We conclude that eicosanoids are present in high
concentrations in infants with PPHN. Iatrogenic factors, including oxygen
and barotrauma, appear to correlate with their concentrations. Removal of
these factors is associated with decreased production of mediators and
clinical improvement.
