Increased hyaluronic acid production in lung--a possible important factor in interstitial and alveolar edema during general anesthesia and in adult respiratory distress syndrome.

The tremendous swelling potential of hyaluronic acid (HA) is well established, however, the possible role of HA for interstitial and alveolar edema of the lung during general anesthesia and in adult respiratory distress syndrome (ARDS) has not received attention. Bronchoalveolar lavage (BAL) was therefore performed on 28 apparently lung-healthy patients; first 24 h prior to induction of general anesthesia and then--in the same lung segment--approximately 30 min after anesthesia induction with endotracheal intubation and mechanical ventilation with N2O in O2. The second BAL was undertaken prior to surgery. Another group of 11 patients with ARDS was also subjected to BAL. A third control group of 10 patients was investigated with BAL 24 h apart to see if a prior BAL influenced the second BAL. Prominent findings were that induction of general anesthesia was associated with significantly (P less than 0.001) increased amount of HA in BAL, on average 77 micrograms/l (range 24-181 micrograms/l) as compared with HA-level 24 h before anesthesia, where all values were below 20 micrograms/l. ARDS patients ranged from 72 to 1636 micrograms/l with a mean of 515 micrograms/l, which was significantly (P less than 0.001) higher than HA-level after induction of anesthesia. The control group that had BAL of the same lung segment 24 h apart did not show any increase in HA-level during the second BAL; with HA-level below 20 micrograms/l.(ABSTRACT TRUNCATED AT 250 WORDS)