Early Diagnosis of Pulmonary Circulatory Disorders in Acute Lung Lesions in Critically Ill Patients

Abstract

The most severe sequels of acute lung lesions are manifested by the impairment of ventilation-perfusion relations, by the development of primary pulmonary hypertension, by circulatory disorders and the increased content of extravascular fluid in the lung, whose diagnosis is extremely difficult. The purpose of the study was to access the capacities of early diagnosis of systemic hemodynamic and pulmonary circulatory disorders in acute lung lesion in patients with critical states. Hydro- and hemodynamics was evaluated in 32 persons in the early phase of intoxications with neurotropic poisons, in 15 with severe concomitant injury, and in 22 patients with critical states intensively treated cardiac surgery. Hemodynamics was determined, by concomitantly using the integral body rheography technique after M. I. Tishchenko and transthoracic impedance cardiogra-phy. The rheographic techniques could evaluate the state of systemic hemodynamics, the nature and effectiveness of pulmonary pulsatile blood flow, that depended on pulmonary hypertension, and increased thoracic fluid. The determination of the level of lactate and its arterial and venous blood ration with consideration of lactate clearance enabled the authors to evaluate both the effectiveness of systemic perfusion and impaired metabolic processes in the lung. Drastically decreased pulsatile blood flow, ineffective volumetric load, low oxygenation index, increased thoracic fluid volume, and the ratios of the arterial to venous blood concentration of lactate with its normal clearance may be early signs of acute lung lesion.