Advertisement

Canadian Anaesthetists’ Society Journal

, Volume 22, Issue 1, pp 39–49 | Cite as

Early changes in lung water after haemorrhagic shock in pigs and dogs

  • William H. Noble
Article

Summary

This study has demonstrated a 34 per cent rise in lung water after shock and retransfusion of blood. This extra lung water was associated with increased pulmonary artery pressure, increased pulmonary vascular resistance and reduced myocardial performance. These findings occurred despite the failure of arterial pressure to return to normal after retransfusion of blood. Although this increased lung water is less than anything which can be detected clinically it may represent the beginnings of the shock lung syndrome as oedema progresses over period of weeks. A reasonable approach to the problem should include attempts to reduce the elevated pulmonary vascular resistance. NaHCOg should be infused before or during administration of the first bottle of blood in an attempt to improve myocardial function and reduce pulmonary vascular resistance. Fluids should not be infused simply to return arterial pressure to a level considered normal but with consideration to pressures in the pulmonary vascular bed. Pulmonary artery and wedge pressure monitoring with Swan Ganz catheters may improve the management of shock patients.

Keywords

Pulmonary Artery Pressure Pulmonary Vascular Resistance CANADIAN Anaesthetist Left Atrial Pressure Myocardial Performance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Cette étude effectuée chez l’animal a démontré une augmentation de 34 pour cent du volume liquidien pulmonaire après production de choc hémorragique et retransfusion du sang enlevé. On a observé parallèlement une augmentation de la pression de l’artère pulmonaire, de la résistance vasculaire pulmonaire et une diminution du débit cardiaque. Ces changements sont survenus bien que les chiffres de P.A. n’aient pas remonté aux niveaux précédant la saignée. Bien que l’augmentation du volume liquidien pulmonaire observée soit trop petite pour être diagnostiquée cliniquement, elle peut être le début d’un syndrome de “poumon de choc” alors que l’oedème continue à progresser durant les semaines suivantes.

Considérant ces faits, un traitement préventif devrait viser à diminuer la pression vasculaire pulmonaire.

L’on devrait administrer du bicarbonate avant ou durant l’administration du sang (acide) afin d’améliorer la fonction myocardique et diminuer la résistance vasculaire pulmonaire. L’on devrait garder à l’esprit les problèmes pulmonaires possibles lorsque l’on refait le volume sanguin et ne pas uniquement viser à retrouver la pression artérielle initiale. A cet égard, la mesure des pressions pulmonaires à l’aide d’un catéther Swan-Ganz peut rendre de grands services dans le traitement du choc hémorragique.

References

  1. 1.
    Bergofsky, E.H. The adult acute respiratory distress syndrome following nonthoracic trauma. The lung in shock. Amer. Journal of Cardiology26: 619–624 (1970).CrossRefGoogle Scholar
  2. 2.
    Eaton, R.M., Czebrinski, E.W., &Smith, J.R. Observations on pulmonary arterial pressure and peripheral venous pressure following arterial blood loss. J. Thor. Surg.14: 399–405(1945).Google Scholar
  3. 3.
    Blaisdell, F.W., Lim, R.C., Jr., &Stallones, R.J. The mechanism of pulmonary damage following traumatic shock. Sur. Gyn. Obs.130: 15–22 (1970).Google Scholar
  4. 4.
    Carlson, L.A., quoted byMoore, F.D., Lyons, J.H., Jr.,Pierce, F.C., Jh., Morgan, A.P., Jr.,Drinker, P.A., MacArthur, J.D., &Dammin, C.J. Post-traumatic pulmonary insufficiency. Philadelphia, 1969, W.B. Saunders Company, Chap. 6.Google Scholar
  5. 5.
    Noble, W.H. &Sevehinghaus, J.W. Thermal and conductivity dilution curves for rapid quantitation of pulmonary oedema. J. Applied Physiol.32: 770–775 (1972).Google Scholar
  6. 6.
    Noble, W.H., Obdrzalek, J., &Kay, J.C. A new technique for measuring pulmonary oedema. J. Applied Physiol.34: 508–512 (1973).Google Scholar
  7. 7.
    Moss, G.S. Pulmonary involvement in hypovolemic shock. Am. Rev. Med. 201–228 (1972).Google Scholar
  8. 8.
    Kim, S.I. &Shoemaker, W.C. Role of the acidosis in the development of increased pulmonary vascular resistance and shock lung in experimental hemorrhagic shock. Surgery73: 723–729(1973).PubMedGoogle Scholar
  9. 9.
    Famewo, CE., Noble, W.H., & Garvey, M.B. Use of aspirin in hemorrhagic shock. Submitted C.A.S.J.Google Scholar
  10. 10.
    Noble, W.H., Kovacs, K., &Kay, J.C. Fine structural changes in haemodynamic pulmonary oedema. C.A.S.J.21: 275–284 (1974).Google Scholar

Copyright information

© Canadian Anesthesiologists 1975

Authors and Affiliations

  • William H. Noble
    • 1
  1. 1.Department of AnaesthesiaSt. Michael’s Hospital, and University of TorontoToronto

Personalised recommendations