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The role of the lung in postinjury multiple organ failure
David J Ciesla1, Ernest E Moore, Jeffrey L Johnson
1Department of Surgery, Denver Health Medical Center, Denver, Colorado 80204, USA. David.ciesla@dhha.org
Background:
Postinjury multiple organ failure (MOF) is a result of a dysfunctional inflammatory response to severe injury and shock. Acute lung injury is thought to promote further organ dysfunction by the systemic release of inflammatory mediators from injured lung tissue. Although clinical evidence supports this model, a clear understanding of the relationship between lung dysfunction and multiple organ failure has yet to be defined. We hypothesized that respiratory dysfunction is an early obligate event in the progression of postinjury MOF.
Methods:
Data were collected prospectively on 1,344 trauma patients at risk for postinjury MOF. Inclusion criteria were age greater than 16 years, trauma intensive care unit admission, Injury Severity Score greater than 15, and survival longer than 48 hours. Isolated head injuries and head injuries with an extracranial abbreviated injury score of less than 2 were excluded. Daily physiologic and laboratory data were collected through surgical intensive care unit day 28 and clinical events were recorded thereafter until death or hospital discharge. Organ failure was characterized using the Denver MOF scale.
Results:
Organ dysfunction was observed in 1,011 (75%) of 1,344 patients. Lung dysfunction was observed in 951 (94%) patients with 1 or more organ dysfunctions and 598 (99%) of 605 patients with 2 or more organ dysfunctions. Lung dysfunction preceded heart, liver, and kidney dysfunction by an average of 0.6 +/- 0.2 days, 4.8 +/- 0.2 days, and 5.5 +/- 0.5 days, respectively. The severity of lung dysfunction correlated with the severity of heart, liver, and kidney dysfunction, and the number of other dysfunctional organ systems.
Conclusions:
Postinjury respiratory dysfunction is an obligate event that precedes heart, liver, and kidney failure. The severity of other organ dysfunction is related directly to the severity of respiratory dysfunction. These data implicate lung dysfunction as central to the promotion of pathogenic inflammation and the development of postinjury MOF.
Insights
Respiratory dysfunction is an early, critical step in postinjury multiple organ failure (MOF). Lung injury severity directly impacts the progression and severity of heart, liver, and kidney failure in trauma patients.
Area of Science:
- Trauma critical care medicine
- Pathophysiology of organ failure
- Inflammatory response syndromes
Background:
- Multiple organ failure (MOF) following severe injury and shock stems from a dysregulated inflammatory response.
- Acute lung injury is suspected to exacerbate MOF through systemic inflammatory mediator release.
- The precise relationship between lung dysfunction and subsequent organ failure remains incompletely understood.
Purpose of the Study:
- To investigate the hypothesis that respiratory dysfunction is an early, essential event in the cascade leading to postinjury MOF.
- To define the temporal relationship between lung dysfunction and failure in other organs.
- To determine if the severity of lung dysfunction correlates with the extent of other organ failures.
Main Methods:
- Prospective data collection from 1,344 trauma patients meeting specific intensive care unit admission criteria.
- Exclusion of isolated head injuries or minor head trauma.
- Daily physiological and laboratory data monitoring, with clinical event tracking until discharge or death, using the Denver MOF scale for organ failure characterization.
Main Results:
- Organ dysfunction occurred in 75% of patients; lung dysfunction was present in 94% of those with any organ dysfunction.
- Lung dysfunction consistently preceded heart, liver, and kidney dysfunction by 0.6, 4.8, and 5.5 days, respectively.
- The severity of lung dysfunction showed a direct correlation with the severity of dysfunction in other organs and the number of affected systems.
Conclusions:
- Postinjury respiratory dysfunction is a necessary precursor to heart, liver, and kidney failure.
- The degree of respiratory dysfunction directly influences the severity of subsequent organ failures.
- Lung dysfunction appears central to initiating pathogenic inflammation driving the development of postinjury MOF.
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