The 1990 Everett Idris Evans Memorial Lecture: The Inhalation Injury

Abstract

The most important question that had to be answered from our animal data was whether a significant difference existed between the two groups. It could be observed that the resuscitation with Ringer's lactate did not lead to any increased lymph flow or total transcapillary protein flow in spite of the drop in protein and oncotic pressure in plasma. With Ringer's lactate there was a lower lymph to plasma protein ratio, which might be significant. No negative difference could be observed either in the pulmonary capillary wedge pressure or pulmonary vessel resistance. All animals survived throughout the experiment, and in all experiments no advantages regarding the vital parameters could be ascertained with the administration of albumin; however, several factors must be borne in mind. The inhalation injury was from a heat source alone and no toxic substances were involved. Only inhalation trauma was induced in the absence of a surface burn wound. The duration of the observation was for only 36 hours. Thus some caution must be observed in applying these findings to a clinical situation. In our evaluation of the clinical results, we have seen that no differences could be established in regard to pulmonary capillary wedge pressure and extravascular lung water between the Ringer's lactate and the albumin group. In spite of a 50% drop in oncotic pressure, however, this is only valid for the first 24 to 36 hours, after which one could assume that a further protein drop coupled with a still raised hydrostatic filtration coefficient would lead to interstitial edema.(ABSTRACT TRUNCATED AT 250 WORDS)