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Post-traumatic pulmonary insufficiency

B J Pardy, H A Dudley

Surgery, Gynecology & Obstetrics

|February 1, 1977

Summary

Severe trauma and liver disease can cause life-threatening pulmonary insufficiency by impairing the hepatic reticuloendothelial system, which normally filters the blood. Evaluating this system

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Area of Science:

Immunology
Pulmonology
Hepatology

Background:

Pulmonary insufficiency is a serious complication of severe non-thoracic trauma and liver disease, including cirrhosis and hepatic failure.
Both conditions share symptoms like altered consciousness and increased susceptibility to gastrointestinal infections.
The hepatic reticuloendothelial system (HRES) is implicated, not parenchymal cells, as its dysfunction aligns with post-traumatic pulmonary insufficiency.

Purpose of the Study:

To investigate the role of the hepatic reticuloendothelial system (HRES) in preventing pulmonary insufficiency.
To explore the mechanisms by which noxious material accumulates in the lungs during hypovolemia and liver dysfunction.
To propose the evaluation of HRES activity as a diagnostic tool for a potential new syndrome.

Main Methods:

Review of existing literature and experimental evidence concerning the HRES, trauma, and liver disease.
Analysis of the interaction between hypovolemia, HRES activity, and pulmonary reticuloendothelial system (PRES) function.
Examination of the mechanisms of noxious material accumulation in the lungs.

Main Results:

The HRES acts as a crucial prepulmonary filter, removing harmful substances from the blood.
Hypovolemia reduces HRES activity and enhances PRES trapping, leading to the accumulation of noxious material in the lungs.
This accumulation results from direct PRES phagocytosis, HRES cell transfer, and polymorphonuclear leukocyte sequestration.

Conclusions:

Failure of the HRES, particularly its filtering capacity, contributes significantly to pulmonary insufficiency following trauma and in liver disease.
Gram-negative infections can further impair HRES function, exacerbating pulmonary issues.
Assessing HRES activity in injured patients may help define a syndrome of reticuloendothelial system failure, with pulmonary insufficiency as a key component.

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