Salicylate pulmonary edema: the mechanism in sheep and review of the clinical literature

Abstract

Several clinical reports of salicylate-induced pulmonary edema led us to investigate the mechanism in a chronic unanesthetized sheep preparation. We infused an aspirin-buffer solution intravenously at rates up to 1,200 mg of aspirin per hour and compared effects on lung lymph flow and lymph protein concentration to those seen after mechanical elevation of pulmonary vascular pressures. Aspirin had little effect on lung vascular pressures but caused lung lymph flow to increase an average of greater than twice baseline. Because lymph protein concentrations were higher for a given lymph flow with aspirin than during mechanical pressure elevation, lymph protein (lymph flow X lymph to plasma protein concentration) increased much more with aspirin. Thus, aspirin appears to cause increased permeability to fluid and protein in the pulmonary vascular bed. Aspirin caused arterial PO2 to decrease from 83 +/- 3 SE mm Hg to 74 +/- 3 mm Hg (P less than 0.05) and caused postmortem extravascular lung water to increase. These findings are supported by a review of the clinical literature, indicating that salicylate pulmonary edema in humans is noncardiac in origin and may occur at doses considered therapeutic for some diseases as well as after overdose.