Pathogenesis and therapy of acute lung injury

  • Henning Pontoppidan
  • Michael A. Rie
Part of the Developments in Critical Care Medicine and Anaesthesiology book series (DCCA, volume 1)


The purpose of this chapter is to review recent research in the pathogenesis and treatment of acute hypoxemic respiratory failure in man. For a more detailed review, the reader is referred to contemporary reviews and reports listed in References 27 and 55.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Albert RK, Lakshminarayan S, Kirk W et al: Extraalveolar vessels leak in oleic acid edema. Am Rev Respir Dis 123: 245, 1981.Google Scholar
  2. 2.
    Bachofen M, Weibel ER: Alterations of the gas exchange apparatus in adult respiratory insufficiency associated with septicemia. Am Rev Respir Dis 116: 589–615, 1977.PubMedGoogle Scholar
  3. 3.
    Bendixen HH, Egbert LD, Hedley-Whyte J, Laver MB, Pontoppidan H: Respiratory care. St Louis: CV Mosby, 1965.Google Scholar
  4. 4.
    Blaisdell FW, Lewis FR Jr: Respiratory distress syndrome of shock and trauma. Major Probl Clin Surg 21: 1–237, 1977.PubMedGoogle Scholar
  5. 5.
    Bressack MA, Bland RD: Intravenous infusion of tolazoline reduces pulmonary vascular resistance and net fluid filtration in the lungs of awake hypoxic newborn lambs. Am Rev Respir Dis 123: 217–221, 1981.PubMedGoogle Scholar
  6. 6.
    Brigham KL, Wolverton WC, Blake LH et al: Increased sheep lung permeability caused by pseudomonas bacteremia. J Clin Invest 54: 792–804, 1975.CrossRefGoogle Scholar
  7. 7.
    Carvalho AC A: In: Zapul W (ed) Excerpts from pulmonary SCOR progress reports, vol 5: Respiratory failure, pp 109–115. National Heart, Lung and Blood Institute Division of Lung Diseases, Bethesda, October 1980.Google Scholar
  8. 8.
    Carvalho AC, Bellman S, Saullo J et al: Altered plasma factor VIII antigen: a sensitive indicator of endothelial damage. Am Rev Respir Dis 123: 98, 1981.Google Scholar
  9. 9.
    Conference on the scientific basis of in-hospital respiratory therapy. Am Rev Respir Dis 122: 1 - 161, 1980.Google Scholar
  10. 10.
    Craddock PR, Fehr J, Brigham KL, Kronenberg RS, Jacob HS: Complement and leukocyte- mediated pulmonary dysfunction in hemodialysis. N Engl J Med 296: 769–774, 1977.PubMedCrossRefGoogle Scholar
  11. 11.
    Dantzker DR, Lynch JP, Weg JG: Depression of cardiac output is a mechanism of shunt reduction in the therapy of acute respiratory failure. Chest 77: 636–642, 1980.PubMedCrossRefGoogle Scholar
  12. 12.
    Deneke SM, Fanburg BL: Normobaric oxygen toxicity of the lung. N Engl J Med 303: 76–86, 1980.PubMedCrossRefGoogle Scholar
  13. 13.
    Erdmann AJ, Zapol WM: 100% oxygen breathing increases lung permeability and lung water in awake sheep. Am Rev Respir Dis [Suppl] 121: 460, 1980.Google Scholar
  14. 14.
    Falke KJ, Pontoppidan H, Kumar A, Leith DE, Geffin B, Laver MB: Ventilation with end expiratory pressure in acute lung disease. J Clin Invest 51: 2315–2323, 1972.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Flick MR, Perel A, Staub N: Increased lung vascular permeability after microemboli in unanesthetized sheep requires circulating leukocytes. Abstr Physiologist 22: 39, 1979.Google Scholar
  16. 16.
    Grant K, Rodvien R, Mielke CH: Altered factor VIII complexes in patients with acute respiratory insufficiency. Thromb Haemost 40: 326–334, 1978.PubMedGoogle Scholar
  17. 17.
    Greene R, Zapol WM, Snider MT, Reid L, Snow R, O’Connel RS. Novelline RA: Early bedside detection of pulmonary vascular occlusion during acute respiratory failure. Am Rev Respir Dis 124:593–601, 1981:Google Scholar
  18. 18.
    Guyton AC, Lindsey AW: Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema. Circ Res 7: 649–657, 1959.PubMedCrossRefGoogle Scholar
  19. 19.
    Hedley-Whyte J, Burgess GE, Feeley TW, Miller MG: Applied physiology of respiratory care. Boston: Little, Brown and Company, 1976.Google Scholar
  20. 20.
    Hemmer M, Suter PM: Treatment of cardiac and renal effects of PEEP with dopamine in patients with acute respiratory failure. Anesthesiology 50: 399–403, 1979.PubMedCrossRefGoogle Scholar
  21. 21.
    Henson PM, Larsen GL, Webster RO et al: Pulmonary microvascular alterations and injury induced by complement fragments: synergistic effect of complement activation, neutrophil sequestration, and prostaglandins. In: Malik AB, Staub NC (ads) Mechanism of lung microvascular injury: proceedings of conference, May 1981. New York: New York Academy of Sciences Press, 1982. New York: New York Academy of Sciences, 1982.Google Scholar
  22. 22.
    Jacob HS, Craddock PR, Hammerschmidt DE, Moldon CF: Complement-induced granulocyte aggregation. An unsuspected mechanism of disease. N Engl J Med 302: 789–794, 1980.PubMedCrossRefGoogle Scholar
  23. 23.
    Kumar A, Pontoppidan H, Baratiz RA, Laver MB: Inappropriate response to increased plasma ADH during mechanical ventilation in acute respiratory failure. Anesthesiology 40: 215–221, 1974.PubMedCrossRefGoogle Scholar
  24. 24.
    Laver B, Strauss HW, Pohost GM: Right and left ventricular geometry: adjustments during acute respiratory failure. Crit Care Med 7: 509–519, 1979.PubMedCrossRefGoogle Scholar
  25. 25.
    Lemaire F, Gastinne H, Regnier B, Teisseire B, Rapin M: Perfusion changes modify intra- pulmonary shunt Qs/Qt in patients with ARDS. Am Rev Respir Dis 117: 144, 1978.Google Scholar
  26. 26.
    Lynch JP, Mhyre JG, Dantzker DR: The influence of cardiac output on intrapulmonary shunt. J Appl Physiol 46: 315–321, 1979.PubMedGoogle Scholar
  27. 27.
    Malik AB, Staub NC (eds): Mechanism of lung microvascular injury: proceedings of conference, May 1981. New York: New York Academy of Sciences Press, 1982.Google Scholar
  28. 28.
    Malik AB, Van der Zee H: Thrombin induced pulmonary insufficiency. Thromb Res 11: 479–506, 1977.CrossRefGoogle Scholar
  29. 29.
    Martyn JAJ, Snider MT, Szyfelbein SK, Burke JF, Laver MB: Right ventricular dysfunction following acute thermal injury. Ann Surg 191: 330–335, 1980.PubMedCrossRefGoogle Scholar
  30. 30.
    Matthay MA, Conhaim RL, Schultz EL et al: How serum in the air spaces of sheep lungs increases lung lymph flow. Am Rev Respir Dis 123: 247, 1981.Google Scholar
  31. 31.
    Murray JF: Conference report: mechanisms of acute respiratory failure. National Heart, Lung, and Blood Institute. Am Rev Respir Dis 115: 1071–1078, 1977.Google Scholar
  32. 32.
    National Heart, Lung and Blood Institute. Extracorporeal support for respiratory insufficiency: a collaborative study in response to RFP NHLI 73–20, p. 10 BHLBI DLD, December 1979.Google Scholar
  33. 33.
    Pappova EW, Bachmeier JL, Crevoisier J et al: Acute hypoproteinemic fluid overload: its determinants, distribution and treatment with concentrated albumin and diuretics. Vox Sang 33: 307–317, 1977.PubMedCrossRefGoogle Scholar
  34. 34.
    Pontoppidan H: Pathophysiology of postoperative pulmonary complications. In: Anesthesiology and intensive care medicine. Berlin: Springer-Verlag, 1979.Google Scholar
  35. 35.
    Pontoppidan H: Mechanical aids to lung expansion in non-intubated surgical patients. Am Rev Respir Dis 122: 109–119, 1980.PubMedGoogle Scholar
  36. 36.
    Pontoppidan H, Geffin B, Lowenstein E: Acute respiratory failure in the adult. Medical progress article (three parts). N Engl J Med 287:690, 743–752, 799–806, 1972.Google Scholar
  37. 37.
    Pontoppidan H, Wilson RS, Rie MA et al: Respiratory intensive care. Anesthesiology 47: 96–116, 1977.PubMedCrossRefGoogle Scholar
  38. 38.
    Pratt PC, Vollmer RT, Shelburne JD et al: Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project: I. Light microscopy. Am J Pathol 95: 191–214, 1979.PubMedGoogle Scholar
  39. 39.
    Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB: Hemodynamic response to mechanical ventilation with PEEP: the effect of hypervolemia. Anesthesiology 43: 45–55, 1975.CrossRefGoogle Scholar
  40. 40.
    Rackow EC, Fein IA, Leppo J: Colloid osmotic pressure as a prognostic indicator of pulmonary edema and mortality in the critically ill. Chest 72: 709–713, 1977.PubMedCrossRefGoogle Scholar
  41. 41.
    Saldeen T: The microembolism syndrome, a review. In: Saldeen T (ed) The microembolism syndrome. Stockholm: Almqvist Wiksell International, pp 7–44.Google Scholar
  42. 42.
    Schneider R, Zapol WM, Carvalho A: Platelet consumption and sequestration in severe acute respiratory failure. An Rev Respir Dis 122: 445–451, 1980.Google Scholar
  43. 43.
    Sibbald WJ, Anderson RR, Reid B, Holliday RL, Dreidger AA: Alveolar capillary permeability in human septic ARDS: effect of high dose corticosteroid therapy. Chest 79:132– 142, 1981.Google Scholar
  44. 44.
    Snider MT, Rie MA, Bingham JB, Lauer J, Urbina A, Strauss HW: Right ventricular performance in ARDS: radionuclid scintiscan and thermal dilution studies [abstr]. Am Rev Respir Dis 121: 192, 1980.Google Scholar
  45. 45.
    Snider MT, Rie MA, Lauer J, Zapol WM: Normoxic pulmonary vasconstriction in ARDS: detection of sodium nitroprusside and isoproterenol infusions. Am Rev Respir Dis 121: 191, 1980.Google Scholar
  46. 46.
    Snow RL, Zapol WM, Reid LM: Morphology of the pulmonary circulation in adult respiratory distress syndrome. Am Rev Respir Dis 121: 192, 1980.Google Scholar
  47. 47.
    Spagnuolo PJ, Ellner JJ, Hassid A et al: Thromboxane A2 mediates augmented polymorph- nuclear leucocyte adhesiveness. J Clin Invest 66: 406–414, 1980.PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Staub NC: Pulmonary edema. Physiol Rev 54: 678–811, 1974.PubMedGoogle Scholar
  49. 49.
    Staub NC: The forces regulating fluid filtration in the lung. Microvasc Res 15: 45–55, 1978.PubMedCrossRefGoogle Scholar
  50. 50.
    Staub NC, Hogg JC: Conference report of a workshop on the measurement of lung water. Crit Care Med 8: 752–759, 1981.CrossRefGoogle Scholar
  51. 51.
    Svennevig JL, Bugge-Asperheim B, Bjorgo S et al: Methylprednisolone in the treatment of lung contusion following blunt chest trauma. Scand J Thorac Cardiovasc Surg 14: 301–305, 1980.PubMedCrossRefGoogle Scholar
  52. 52.
    Terrell K, Holcomb JR, Johanson WG Jr: Correlation between radiographic and physiologic measurements in respiratory failure. Am Rev Respir Dis 123: 89, 1981.Google Scholar
  53. 53.
    Webster RO, Larsen GL, Henson PM: Lack of inflammatory effects on the rabbit lung of intravascular complement activation. Fed Proc 40: 767, 1981.Google Scholar
  54. 54.
    Weil MH, Henning RJ, Morissette M, Michaels S: Relationship between colloid osmotic pressure and pulmonary artery wedge pressure in patients with acute cardiopulmonary failure. Am J Med 64: 643–650, 1978.Google Scholar
  55. 55.
    West J: Pulmonary pathophysiology: the essentials. Baltimore: Williams and Watkins, 1977.Google Scholar
  56. 56.
    Viigilio RW, Rice CL, Smith DE et al: Crystalloid versus colloid resuscitation: is one better? Surgery 85: 129–139, 1979.Google Scholar
  57. 57.
    Zapol WM, Kobayashi K, Snider MT et al: Vascular obstruction causes pulmonary hypertension in severe acute respiratory failure. Chest [suppl] 71: 306–307, 1977.Google Scholar
  58. 58.
    Zapol WM, Snider MT: Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296: 476–480, 1977.PubMedCrossRefGoogle Scholar
  59. 59.
    Zapol WM, Snider MT, Schneider RC et al: Pulmonary hypertension in severe acute respiratory failure. In: Zapol WM, Qvist J (eds) Artificial lungs for acute respiratory failure: theory and practice. New York: Academic Press, 1976, pp 435–454.Google Scholar
  60. 60.
    Zapol WM, Trelstad RL, Coffey JW et al: Pulmonary fibrosis in severe acute respiratory failure. Am Rev Respir Dis 119: 547–554, 1979.PubMedGoogle Scholar
  61. 61.
    Zarins CK, Rice CL, Peters RM et al: Lymph and pulmonary response to isobaric reduction in plasma oncotic pressure in baboons. Circ Res 43:925 –930,1978.Google Scholar
  62. 62.
    Zetterstrom H: Plasma oncotic pressure and lung function. Clinical and experimental aspects. PhD thesis. Acta Univ Upsaliensis, 1980.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1982

Authors and Affiliations

  • Henning Pontoppidan
  • Michael A. Rie

There are no affiliations available

Personalised recommendations