Abstract
BackgroundTrauma and surgery may be complicated by pulmonary dysfunction, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), but the mechanisms are incompletely understood.MethodsWe evaluated lung capillary protein permeability non-invasively with help of the 67Ga-transferrin pulmonary leak index (PLI) technique and extravascular lung water (EVLW) by the transpulmonary thermal-dye dilution technique in consecutive, mechanically ventilated patients in the intensive care unit within 24 h of direct, blunt thoracic trauma (n = 5, 2 with ARDS), and within 12 h of indirect trauma by transhiatal oesophagectomy (n = 8), abdominal surgery for cancer (n = 6) and bone surgery (n = 4). We studied transfusion history, haemodynamics, oxygenation and mechanics of the lungs. The lung injury score (LIS, 0–4) was calculated. Plain radiography was also done to judge densities and atelectasis.ResultsThe PLI and EVLW were elevated above normal in 61 and 30% of patients, respectively, and the PLI directly related to the number of red cell concentrates given (rs = 0.69, P < 0.001), without group differences. Oxygenation, lung mechanics, radiographic densities and thus the LIS (1.0 [0.25–3.5]) did not relate to PLI and EVLW. However, groups differed in oxygenation and airway pressures and impaired oxygenation related to the number of radiographic quadrants with densities (rs = 0.55, P = 0.007). Thoracic trauma patients had a worse oxygenation requiring higher airway pressures and thus higher LIS than the other patient groups, unrelated to PLI and EVLW but attributable to a higher cardiac output and thereby venous admixture. Finally, patients with radiographic signs of atelectasis had more impaired oxygenation and more densities than those without.ConclusionThe oxygenation defect and radiographic densities in mechanically ventilated patients with pulmonary dysfunction and ALI/ARDS after trauma and surgery are likely caused by atelectasis rather than by increased permeability-oedema related to red cell transfusion.
Highlights
Trauma and surgery may be complicated by pulmonary dysfunction, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), but the mechanisms are incompletely understood
Trauma and major surgery may be complicated by pulmonary dysfunction and acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) [1]
We used the non-invasive 67Ga-transferrin pulmonary leak index (PLI) measured at the bedside to assess permeability, and the transpulmonary thermal-dye dilution for assessment of accessible extravascular lung water (ELVW) and thereby to indirectly estimate atelectasis, which can be hard to differentiate from oedema, even sometimes by computer tomography (CT) scanning [210]
Summary
Trauma and surgery may be complicated by pulmonary dysfunction, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), but the mechanisms are incompletely understood. Trauma and major surgery may be complicated by pulmonary dysfunction and acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) [1]. Other types of abdominal surgery, including liver resections, may result in postoperative pulmonary complications in 10 to 70% of patients, with atelectasis, pneumonia or oedema/ALI [9,13,16,23,24]. The pathogenesis and contribution of red cell transfusion, increased permeability-oedema and atelectasis to ventilatory and radiographic abnormalities after trauma and (non-cardiovascular) surgery is incompletely understood [6,9,13,16,20,21,22,24]
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