Lung Water Changes After Thermal Injury
- 1 October 1980
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 192 (4), 479-490
- https://doi.org/10.1097/00000658-198010000-00007
Abstract
Respiratory failure after thermal injury is common, but the etiologic roles of high volume crystalloid resuscitation, hypoproteinemia, inhalation injury, or sepsis have not been specifically defined in human studies. We used the thermal-green dye double indicator dilution measurement of extravascular lung water (EVLW) to follow daily lung water changes in seven severely burned adult patients, resuscitated with only crystalloid solutions. An average weight gain of 21.3 kg, a 30% increase (p < 0.001), was present two to three days after admission. Admission EVLW for all patients was 7.9 ± 1.2 ml/kg, (means ± SD), and EVLW at the time of maximal weight gain was 5.9 ± 1.4 ml/kg, a 25% decrease (p < 0.05). Admission pulmonary artery wedge pressure (PAWP) was 8 ± 3 mmHg, which was not significantly different from PAWP of 13 ± 4 mmHg at the time of maximal weight gain. In the three patients who died of sepsis, their terminal weight averaged 17.8 kg (27%) above their admitting weight (p < 0.01) and EVLW was 26.4 ± 4.4 ml/kg, a 200% increase (p < 0.02) from admission. Their terminal PAWP averaged 22 ± 2 mmHg, a 170% increase (p < 0.005). None of these patients had an increase in EVLW until clinical signs of sepsis occurred and the rise in EVLW preceded the rise in PAWP. Calculated mean plasma colloid osmotic pressure (PCOP) on admission was 20.7 ± 4.9 mmHg; at the time of maximal weight gain, it was 8.6 ± 1.7 mmHg (p < 0.001). The PCOP-PAWP gradient fell to −4 ± 4 mmHg (p < 0.001) at the time of maximal weight gain and remained less than +4 mmHg throughout the study period in all patients. We conclude that massive crystalloid resuscitation while maintaining PAWP below 15 mmHg does not cause an increase in EVLW during the first four days after thermal injury. EVLW actually decreases slightly in all patients despite marked weight gain, hypoproteinemia and a negative PCOP-PAWP gradient. EVLW does not correlate with the PCOP-PAWP gradient in either septic or nonseptic periods. Three patients had severe inhalational injury and normal EVLW for the first four postburn days. It therefore appears that significant interstitial edema does not result from inhalational injury. There is also no evidence that thermal injury causes an early increase in pulmonary capillary permeability. The occurrence of sepsis, however, results in rapid accumulation of lung water, without any change in hydrostatic or osmotic forces. This study supports the primary role of sepsis in altering pulmonary capillary permeability with resulting pulmonary edema.Keywords
This publication has 33 references indexed in Scilit:
- Changes in lung water and capillary permeability following sepsis and fluid overloadJournal of Surgical Research, 1980
- Is There a Selective Increase in Pulmonary Capillary Permeability Following Cutaneous Burns?Chest, 1979
- Documentation of pulmonary capillary permeability in the adult respiratory distress syndrome accompanying human sepsis.Published by Elsevier BV ,1979
- Effect of major thermal injury on the pulmonary microcirculation.1978
- Lung Water Changes After Thermal BurnsAnnals of Surgery, 1978
- Burn edema and protein leakage in the ratMicrovascular Research, 1978
- Microprocessor determination of lung water using thermal-green dye double indicator dilution.1978
- PROGRESSIVE PULMONARY INSUFFICIENCY AND OTHER PULMONARY COMPLICATIONS OF THERMAL INJURYJournal Of Trauma-Injury Infection and Critical Care, 1975
- DISTRIBUTION AND LOSSES OF PLASMA PROTEINS DURING THE EARLY STAGE OF SEVERE BURNSAnnals of the New York Academy of Sciences, 1968
- A STUDY OF CAPILLARY PERMEABILITY IN EXPERIMENTAL BURNS AND BURN SHOCK USING RADIOACTIVE DYES IN BLOOD AND LYMPH 1JCI Insight, 1944