Abstract
Lung structural changes were evaluated by radiographic infiltration and compared with functional changes by pulmonary venous admixture or shunt ( $$\dot Qsp/\dot Qt$$ ) and blood gases (PaO2/FiO2 ratio, which is the ratio of arterial oxygen tension to oxygen concentration of inspired gas) in 70 consecutive severely traumatized patients. Of these, 36 (51%) developed adult respiratory distress syndrome (ARDS) by clinical and physiologic criteria, and 34 (49%) did not develop ARDS; 42 patients sustained direct pulmonary injury from penetrating stab or gunshot wounds; 24/36 (67%) of those with ARDS and 28 (40%) of the entire series died. The study showed a rough direct correlation of a semiquantitative infiltration score with pulmonary shunt and an indirect correlation with the PaO2/FiO2 ratio during the initial resuscitation and the subsequent posttrauma course in both ARDS and non-ARDS patients. The temporal pattern of the infiltration score closely paralleled that of the pulmonary shunt pattern and inversely paralleled the PaO2/FiO2 ratios throughout the period of observation, indicating that radiographic structural changes developed concomitantly with functional changes. To avoid confounding issues, we studied only young, previously healthy trauma victims without head injury. Data from patients with direct lung injury were stratified and evaluated separately. The earliest observed changes most often occurred in the upper and middle lung fields; by contrast, most mechanically ventilated trauma patients had varying degrees of infiltration in the bases with some dysfunction, but not enough to meet ARDS diagnostic criteria.
Published Version
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