RESPIRATORISCHE UND HAMODYNAMISCHE FOLGEN EINER EINSEITIGEN INHALATIONSVERLETZUNG DER LUNGE

Translated title of the contribution: Effects of one-lung inhalation injury on hemodynamic and respiratory parameters

J. L. Theissen, T. Prien, J. Maguire, H. L. Lubbesmeyer, L. D. Traber, David Herndon, D. L. Traber

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Respiratory failure after smoke inhalation injury is usually preceded by a 12-48 h interval with only minor clinical symptoms. Since pulmonary lesions show a patchy distribution, it has been postulated that vasoconstriction in more severely damaged areas induces a shift of pulmonary blood flow to less severely damaged areas, minimizing venous admixture. This hypothesis was tested in a sheep model in which only one lung was exposed to smoke. Six chronically instrumented (arterial, central venous, pulmonary artery thermodilution, and left atrial catheters; ultrasonic transit time flow probe around the left pulmonary artery) range ewes were intubated with a modified Carlens tube under halothane anesthesia. Smoke from smoldering cotton was insufflated into the left lung until a carboxyhemoglobin level of 50% was achieved. After the smoking procedure, the animals were awakened, extubated, and studied for 24 h. During this time, the pulmonary vascular resistance of the left lungs increased fourfold while the pulmonary vascular resistance of both lungs only doubled. Left pulmonary artery blood flow decreased progressively to 37% of control at 24 h, while cardiac output decreased by only 25%. PaO2 decreased from 107 ± 12 to 77 ± 15 mmHg at 24 h. Mean pulmonary arterial pressure rose from 18 to 23 mmHg. Heart rate, mean arterial pressure, left atrial pressure, and PaCO2 showed no statistically significant changes. The results indicate that the response of the pulmonary vasculature to smoke inhalation injury is a two-phase phenomenon. In the first phase, vasoconstriction occurs to counterbalance injury-induced ventilation-perfusion mismatching. The diversion of pulmonary blood flow from more severely damaged areas to better ventilated areas maintains the PaO2 within the normal physiological range. In a second phase, progressive mechanical airway obstruction, release of vasoconstrictive mediators, and cellular plugging of the pulmonary vasculature result in an increase of pulmonary arterial pressure, which then leads to progressive failure of the compensatory adaptation phenomena.

Original languageGerman
Pages (from-to)531-535
Number of pages5
JournalAnaesthesist
Volume38
Issue number10
StatePublished - 1989

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Lung Injury
Inhalation
Hemodynamics
Lung
Smoke Inhalation Injury
Pulmonary Artery
Arterial Pressure
Vasoconstriction
Smoke
Vascular Resistance
Carboxyhemoglobin
Thermodilution
Atrial Pressure
Halothane
Airway Obstruction
Ultrasonics
Respiratory Insufficiency
Cardiac Output
Ventilation
Sheep

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Theissen, J. L., Prien, T., Maguire, J., Lubbesmeyer, H. L., Traber, L. D., Herndon, D., & Traber, D. L. (1989). RESPIRATORISCHE UND HAMODYNAMISCHE FOLGEN EINER EINSEITIGEN INHALATIONSVERLETZUNG DER LUNGE. Anaesthesist, 38(10), 531-535.

RESPIRATORISCHE UND HAMODYNAMISCHE FOLGEN EINER EINSEITIGEN INHALATIONSVERLETZUNG DER LUNGE. / Theissen, J. L.; Prien, T.; Maguire, J.; Lubbesmeyer, H. L.; Traber, L. D.; Herndon, David; Traber, D. L.

In: Anaesthesist, Vol. 38, No. 10, 1989, p. 531-535.

Research output: Contribution to journalArticle

Theissen, JL, Prien, T, Maguire, J, Lubbesmeyer, HL, Traber, LD, Herndon, D & Traber, DL 1989, 'RESPIRATORISCHE UND HAMODYNAMISCHE FOLGEN EINER EINSEITIGEN INHALATIONSVERLETZUNG DER LUNGE', Anaesthesist, vol. 38, no. 10, pp. 531-535.
Theissen JL, Prien T, Maguire J, Lubbesmeyer HL, Traber LD, Herndon D et al. RESPIRATORISCHE UND HAMODYNAMISCHE FOLGEN EINER EINSEITIGEN INHALATIONSVERLETZUNG DER LUNGE. Anaesthesist. 1989;38(10):531-535.
Theissen, J. L. ; Prien, T. ; Maguire, J. ; Lubbesmeyer, H. L. ; Traber, L. D. ; Herndon, David ; Traber, D. L. / RESPIRATORISCHE UND HAMODYNAMISCHE FOLGEN EINER EINSEITIGEN INHALATIONSVERLETZUNG DER LUNGE. In: Anaesthesist. 1989 ; Vol. 38, No. 10. pp. 531-535.
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