[Acute lung failure following thoracic trauma].

Area of Science:

• Trauma and Critical Care Medicine
• Pulmonary Medicine
• Pathophysiology

Background:

• Acute lung failure (ALF) is a common complication in multiple organ failure (MOF).
• Increased pulmonary microvascular permeability (PMVP) is a key factor in ALF development.
• Understanding the sequence of PMVP and ALF after direct lung insults is crucial.

Purpose of the Study:

• To investigate the sequence of PMVP and ALF development following direct lung insults in trauma patients.
• To differentiate between early and late ALF manifestations and their underlying mechanisms.
• To assess the role of thoracic injury in posttraumatic ALF.

Main Methods:

• Prospective study of 255 trauma patients in an ICU.
• Defined ALF, sepsis syndrome, and MOF using established scoring systems.
• Measured PMVP using gamma camera scintigraphy with specific radiotracers (113mIn-transferrin and 99mTc-erythrocytes).
• Quantified PMVP using the pulmonary microvascular permeability index (PMVPI).

Main Results:

• 21% of trauma patients developed ALF, with 96% also developing MOF.
• Direct lung injury, particularly thoracic trauma, was the primary cause of early ALF (within 72 hours).
• Direct thoracic injury initially increased PMVP in the injured lung, followed by a significant increase in the contralateral lung within 4 days.

Conclusions:

• Direct lung injury, especially thoracic trauma, is the dominant mechanism for early posttraumatic ALF.
• Increased PMVP in injured lung areas is an early indicator of ALF.
• A subsequent inflammatory response may lead to increased PMVP in previously healthy lung regions, contributing to late-phase ALF.