Generalized vascular permeability and pulmonary function in patients following serious trauma

It has been suggested that the adult respiratory distress syndrome (ARDS) is a manifestation of a generalized vascular permeability defect. Low-level urinary albumin excretion reflects changes in systemic vascular permeability in a variety of acute inflammatory conditions including trauma. To test the hypothesis that impaired pulmonary function is associated with increased systemic vascular permeability, 44 trauma patients with Injury Severity Scores (ISS) ranging from 9 to 75 were studied over 3 days. Urinary albumin was measured from admission and expressed as the albumin/creatinine ratio (ACR). In 24 mechanically ventilated patients mean inspired oxygen/fraction (FIO2) and mean arterial oxygen tension (PO2) were used to calculate the PO2/FIO2 ratio. For each study day patients were divided into group I, mean FIO2 > 0.5; group II, mean FIO2 < 0.5; and group III, those breathing spontaneously. During the first posttrauma period the log ACR and the PO2/FIO2 ratio were inversely related (r = -0.712; p < 0.001), and the log ACR predicted PO2/FIO2 independent of ISS (p = 0.001). The log mean ACR (SD) for groups I and III were 34.0 (5.6) and 8.7 (2.9) mg/mmol, respectively (Mann Whitney p = 0.013). Following trauma, pulmonary dysfunction is associated with increased vascular permeability in remote organs.