Regulation of the Pulmonary Circulation During Lung Injury
Adult respiratory distress syndrome (ARDS)  is not a disease but a disorder which is associated with many clinical states, the most frequent being sepsis, trauma, and aspiration of gastric contents . Less frequently occurring situations are amniotic fluid embolization, acute pancreatitis, radiation lung injury, disseminated intravascular coagulation, and ARDS induced by certain drugs . ARDS was described approximately 20 years ago, yet, since its description the overall mortality has remained stable, indicating that, although some aspects of this syndrome have been studied in various model systems [4–8, 11, 14, 15], the impact of these experiments on patient survival has been very small . Conceptually, ARDS is a massive insult damaging the integrity of the lung membranes. The event which triggers a cascade of metabolic reactions is acute; occasionally the syndrome is rather transient, but most frequently the lung subsequently undergoes a chronic inflammatory phase which leads to cell proliferation and scar tissue formation . The lung circulation is involved in the syndrome since the injurious agents, for example lipopolysaccharide or activated circulating cells, are often carried to the lung via the bloodstream. Pulmonary hypertension has been recognized as part of the syndrome in many patients, as described by Zapol and Snider in 1977 . Morphological studies show obliteration of pulmonary arteries, perivascular edema, and compression of the microcirculation by edema fluid.
KeywordsLung Injury Acute Lung Injury Lipid Mediator Adult Respiratory Distress Syndrome Scar Tissue Formation
Unable to display preview. Download preview PDF.
- 7.Chang S, Czartolomna J, Voelkel NF (1990) Role of eicosanoids in staphylococcal α-toxin induced lung injury in the rat. J Appl Physiol (to be published)Google Scholar
- 8.Chang S, Fernyak S, Voelkel NF (1990) Post-treatment with WEB 2086, a platelet activating factor antagonist, decreases lung injury in endotoxin-treated rats. Am J Physiol 258 153–158, 1990Google Scholar
- 10.Graham LM, Vasil A, Vasil ML, Voelkel NF, Stenmark KR (1990) Decreased pulmonary vasoreactivity in an animal model of chronic Pseudomonas pneumonia. Am Rev Resp Dis 142, 221–229, 1990Google Scholar
- 11.Hanley PJ, Sienko A, Light RB (1988) Role of prostacyclin and thromboxane in the circulatory changes of acute bacteremic Pseudomonas pneumonia in dogs. Am Rev Respir Dis 137:700–706Google Scholar
- 16.Prescott CM, Zimmerman GA, McIntyre TM (1987) The production of platelet-activating factor by cultured human endothelial cells: regulation and function. In: Snyder F (ed) Platelet -activating factor and related lipid mediators. Plenum, New York, pp 323–340Google Scholar
- 17.Sakai A, Chang S, Voelkel NF (1989) The importance of vasoconstriction in lipid mediator induced pulmonary edema. J Appl Physiol 66, 2667–2674, 1989Google Scholar