Endothelial Glycocalyx Layer: A Possible Therapeutic Target for Acute Lung Injury during Lung Resection

BACKGROUND: Shedding of the endothelial glycocalyx layer (EGL) is known to occur during major surgery, but its degradation associated with minimally invasive video-assisted thoracoscopy (VATS) remains unclear. We investigated if serum biomarkers of EGL disruption were elevated during VATS lobectomy, and whether the urinary trypsin inhibitor (UTI) ulinastatin exerted a protective effect during this procedure. MATERIALS AND METHODS: Sixty ASA II-III lung cancer patients undergoing elective VATS lobectomy were divided equally into UTI and control groups. UTI group patients received intravenous UTI during surgery. Serum levels of syndecan-1 and heparan sulfate were examined before (T0) and at the end of surgery (T1). Serum albumin and hemoglobin were measured before surgery (BOD) and on the first postoperative day (POD1). RESULTS: In control group, syndecan-1 levels were significantly elevated at T1 compared with T0 (3.77 ± 3.15 versus 4.28 ± 3.30, P = 0.022(⁎)) and increased even more significantly in patients whose surgery lasted >3 h (3.28 ± 2.84 versus 4.31 ± 3.39, P = 0.003(⁎⁎)). Serum albumin levels on POD1 were significantly lower in control group compared with UTI group (32.63 ± 4.57 versus 35.76 ± 2.99, P = 0.031(⁎)). CONCLUSION: EGL degradation occurs following VATS lobectomy. UTI can alleviate this shedding, thus helping preserve normal vascular permeability. TRAIL REGISTRATION: This trial is registered with ChiCTR-IOC-17010416 (January 13, 2017).