Advertisement

Acute Lung Injury: The Pathophysiology

  • D. L. Traber
  • L. D. Traber
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1995)

Abstract

Acute lung injury (ALI) is a serious clinical problem. The aspiration of vomitus or the inhalation of smoke are responsible for a high rate of morbidity and mortality in the clinical population. Changes secondary to mechanical manipulation of the airway also play a critical role in the clinical outcome of many patients [1]. Smoke inhalation is a primary factor in the mortality of fire victims [2]. We have developed an ovine model which allows us to study ALI [3]. Immediately after inhalation injury, induced by the insufflation of cotton smoke into the ovine model, the airway shows a marked hyperemia and an increase in microvascular permeability, leading to tracheobronchial edema [4]. Similar findings have been seen in canine preparations after endotracheal insufflation with artificial smoke [5]. The diagnosis of inhalation injury in humans is often made after observing the appearance of airway hyperemia [6]. Consequently, the observations in sheep are similar to those seen in humans with ALI. Other forms of ALI are also associated with an airway hyperemia. An elevated bronchial blood flow was noted with acute exposure to ozone [7]. Similar pulmonary problems have been reported with acid aspiration [8] and mechanical damage induced by endotracheal tubes and the use of ventilators [9, 10].

Keywords

Acute Lung Injury Inhalation Injury Smoke Inhalation Ovine Model Airway Injury 
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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Wiswell TE, Turner BS, Bley JA, Fritz DL, Hunt RE (1989) Determinants of tracheobronchial histologic alterations during conventional mechanical ventilation. Pediatrics 84: 304–311PubMedGoogle Scholar
  2. 2.
    Traber DL, Herndon DN (1990) Pathophysiology of smoke inhalation. In: Haponik EF, Munster AM (eds) Respiratory sequelae of burns. McGraw Hill, New York, pp. 61–73Google Scholar
  3. 3.
    Kimura R, Traber LD, Herndon DN, Linares HA, Lübbesmeyer HJ, Traber DL (1988) Increasing duration of smoke exposure induces more severe lung injury in sheep. J Appl Physiol 64: 1107–1113PubMedGoogle Scholar
  4. 4.
    Herndon DN, Traber LD, Linares H, et al (1986) Etiology of the pulmonary pathophysiology associated with inhalation injury. Resuscitation 14: 43–59PubMedCrossRefGoogle Scholar
  5. 5.
    Hales CA, Barkin P, Jung W, Quinn D, Lamborghini D, Burke J (1989) Bronchial artery ligation modifies pulmonary edema after exposure to smoke with acrolein. J Appl Physiol 67: 1001–1006PubMedGoogle Scholar
  6. 6.
    Schneider W, Berger A, Mailander P, Tempka A (1988) Diagnostic and therapeutic possibilities for fiberoptic bronchoscopy in inhalation injury. Burns Incl Therm Inj 14: 53–57PubMedCrossRefGoogle Scholar
  7. 7.
    Schelegle ES, Gunther RA, Parsons GH, Colbert SR, Yousef MA, Cross CE (1990) Acute ozone exposure increases bronchial blood flow in conscious sheep. Respir Physiol 82: 325–335PubMedCrossRefGoogle Scholar
  8. 8.
    Stothert JC Jr., Basadre JO, Gbaanador GB, et al (1990) Airway aspiration of hydrochloric acid in sheep. Circ Shock 30: 237–254PubMedGoogle Scholar
  9. 9.
    Stothert JC Jr., Gbaanador GB, Basadre J, Flynn J, Traber L, Traber D (1990) Bronchial blood flow and eicosanoid blockade following airway acid aspiration. J Trauma 30: 1483–1488PubMedCrossRefGoogle Scholar
  10. 10.
    Shinozawa Y, Hales C, Jung W, Burke J (1986) Ibuprofen prevents synthetic smoke-induced pulmonary edema. Am Rev Respir Dis 134: 1145–1148PubMedGoogle Scholar
  11. 11.
    Traber DL, Schlag G, Redl H, Traber LD (1985) Pulmonary edema and compliance changes following smoke inhalation. J Burn Care Rehabil 6: 490–494PubMedCrossRefGoogle Scholar
  12. 12.
    Isago T, Noshima S, Traber LD, Herndon DN, Traber DL (1991) Analysis of pulmonary microvascular permeability after smoke inhalation. J Appl Physiol 71: 1403–1408PubMedGoogle Scholar
  13. 13.
    Isago T, Fujioka K, Traber LD, Herndon DN, Traber DL (1991) Derived pulmonary capillary pressure changes after smoke inhalation in sheep. Crit Care Med 19: 1407–1413PubMedCrossRefGoogle Scholar
  14. 14.
    Basadre JO, Sugi K, Traber DL, Traber LD, Niehaus GD, Herndon DN (1988) The effect of leukocyte depletion on smoke inhalation injury in sheep. Surgery 104: 208–215PubMedGoogle Scholar
  15. 15.
    Smith ME, Gunther R, Gee M, Flynn J, Demling RH (1981) Leukocytes, platelets, and thromboxane A2 in endotoxin-induced lung injury. Surgery 90: 102–107PubMedGoogle Scholar
  16. 16.
    Miller WS (1947) The lymphatics. In: Miller WS (ed) The lung. 2nd Edn. Charles C Thomas, Springfield, IL, pp. 89–118Google Scholar
  17. 17.
    Lakshminarayan S, Kowalski TF, Kirk W, Graham MM, Butler J (1990) The drainage routes of the bronchial blood flow in anesthetized dogs. Respir Physiol 82: 65–73PubMedCrossRefGoogle Scholar
  18. 18.
    Charan NB, Turk GM, Dhand R (1984) Gross and subgross anatomy of bronchial circulation in sheep. J Appl Physiol 57: 658–664PubMedGoogle Scholar
  19. 19.
    Abdi S, Herndon DN, Traber LD, et al (1991) Lung edema formation following inhalation injury: Role of the bronchial blood flow. J Appl Physiol 71: 727–734PubMedGoogle Scholar
  20. 20.
    Prien T, Traber LD, Herndon DN, Stothert JC Jr., Lübbesmeyer HJ, Traber DL (1987) Pulmonary edema with smoke inhalation, undetected by indicator-dilution technique. J Appl Physiol 63: 907–911PubMedGoogle Scholar
  21. 21.
    Loick HM, Traber LD, Tokyay R, Linares HA, Prien T, Traber DL (1992) Mechanical alteration of blood flow in smoked and unsmoked lung areas after inhalation injury. J Appl Physiol 72: 1692–1700PubMedGoogle Scholar
  22. 22.
    Lundberg JM, Martling CR, Lundblad L (1988) Cigarette smoke-induced irritation in the airways in relation to peptide-containing, capsaicin-sensitive sensory neurons. Klin Wochenschr 66: 151–160PubMedGoogle Scholar
  23. 23.
    Pernow B (1985) The putative role of neuropeptides in hyperreactivity and inflammation. Eur J Anaesthesiol 2: 155–167PubMedGoogle Scholar
  24. 24.
    Lundberg JM, Alving K, Karlsson JA, Matran R, Nilsson G (1991) Sensory neuropeptide involvement in animal models of airway irritation and of allergen-evoked asthma. Am Rev Respir Dis 143: 1429–1431PubMedGoogle Scholar
  25. 25.
    Alving K (1991) Airways vasodilatation in the immediate allergic reaction. Involvement of inflammatory mediators and sensory nerves. Acta Physiol Scand (Suppl 597): 1–64Google Scholar
  26. 26.
    Traber LD, Herndon DN, Turner J, Sant Ambrogio G, Traber DL (1990) Peptide mediation of the bronchial blood flow elevation following inhalation injury. Circ Shock 31: 13 (Abst)Google Scholar
  27. 27.
    Jansen I, Alafaci C, McCulloch J, Uddman R, Edvinsson L (1991) Tachykinins (substance P, neurokinin A, neuropeptide K, and neurokinin B) in the cerebral circulation: Vasomotor responses in vitro and in situ. J Cereb Blood Flow Metab 11: 567–575PubMedCrossRefGoogle Scholar
  28. 28.
    Constantine JW, Lebel WS, Woody HA (1991) Inhibition of tachykinin-induced hypotension in dogs by CP-96,345, a selective blocker of NK-1 receptors. Naunyn Schmiedebergs Arch Pharmacol 344: 471–477PubMedCrossRefGoogle Scholar
  29. 29.
    Martling CR, Matran R, Alving K, Hokfelt T, Lundberg JM (1990) Innervation of lower airways and neuropeptide effects on bronchial and vascular tone in the pig. Cell Tissue Res 260: 223–233PubMedCrossRefGoogle Scholar
  30. 30.
    Lundberg JM, Franco Cereceda A, Hua X, Hokfelt T, Fischer JA (1985) Co-existence of substance P and calcitonin gene-related peptide-like immunoreactivities in sensory nerves in relation to cardiovascular and bronchoconstrictor effects of capsaicin. Eur J Pharmacol 108: 315–319PubMedCrossRefGoogle Scholar
  31. 31.
    Ellis JL, Undem BJ (1991) Role of peptidoleukotrienes in capsaicin-sensitive sensory fibre-mediated responses in guinea-pig airways. J Physiol (Lond) 436: 469–484Google Scholar
  32. 32.
    Hellewell PG, Henson PM, Downey GP, Worthen GS (1991) Control of local blood flow in pulmonary inflammation: Role for neutrophils, PAF, and thromboxane. J Appl Physiol 70: 1184–1193PubMedGoogle Scholar
  33. 33.
    Ohishi N, Minami M, Kobayashi J, et al (1990) Immunological quantitation and immuno-histochemical localization of leukotriene A4 hydrolase in guinea pig tissues. J Biol Chem 265: 7520–7525PubMedGoogle Scholar
  34. 34.
    Traber DL, Sugi K, Flynn JT, Traber LD (1989) Leukotrienes and lung response to inhalation injury. FASEB J 3: A695 (Abst)Google Scholar
  35. 35.
    Quinn DA, Robinson D, Jung W, Hales CA (1990) Role of sulfidopeptide leukotrienes in synthetic smoke inhalation injury in sheep. J Appl Physiol 68: 1962–1969PubMedGoogle Scholar
  36. 36.
    Goldman G, Welbourn R, Kobzik L, Valeri CR, Shepro D, Hechtman HB (1992) Synergism between leukotriene B4 and thromboxane A2 in mediating acid-aspiration injury. Surgery 111: 55–61PubMedGoogle Scholar
  37. 37.
    Kuhl P, Borbe HO, Fischer H, Romer A, Safayhi H (1986) Ebselen reduces the formation of LTB4 in human and porcine leukocytes by isomerisation to its 5S, 12R-6-trans-isomer. Prostaglandins 31: 1029–1048PubMedCrossRefGoogle Scholar
  38. 38.
    Abdi S, Evans MJ, Cox RA, Lübbesmeyer H, Herndon DN, Traber DL (1990) Inhalation injury to tracheal epithelium in an ovine model of cotton smoke exposure. Early phase (30 minutes). Am Rev Respir Dis 142: 1436–1439PubMedGoogle Scholar
  39. 39.
    Vernersson E, Ahlgren I, Aronsen KF, Koopmann H (1982) The effects of lysine-vasopressin on hemodynamics during early post-burn period in pigs. Acta Chir Scand 148: 491–497PubMedGoogle Scholar
  40. 40.
    Huang YS, Li A, Yang ZC (1988) Effect of smoke inhalation injury on thromboxane levels and platelet counts. Burns Incl Therm Inj 14: 440–446PubMedCrossRefGoogle Scholar
  41. 41.
    Stothert JC, Basadre JO, Herndon D, Traber L, Traber D (1989) Conjugated diene production after airway acid aspiration. Prog Clin Biol Res 299: 69–74PubMedGoogle Scholar
  42. 42.
    Goldman G, Welbourn R, Klausner JM, et al (1990) Attenuation of acid aspiration edema with phalloidin. Am J Physiol 259: L378–L383PubMedGoogle Scholar
  43. 43.
    Goldman G, Welbourn R, Klausner JM, Valeri CR, Shepro D, Hechtman HB (1991) Thromboxane mediates diapedesis after ischemia by activation of neutrophil adhesion receptors interacting with basally expressed intercellular adhesion molecule-1. Circ Res 68: 1013–1019PubMedGoogle Scholar
  44. 44.
    Kimura R, Traber L, Herndon D, Niehaus G, Flynn J, Traber DL (1988) Ibuprofen reduces the lung lymph flow changes associated with inhalation injury. Circ Shock 24: 183–191PubMedGoogle Scholar
  45. 45.
    Stewart RJ, Yamaguchi KT, Knost PM, et al (1990) Effects of ibuprofen on pulmonary oedema in an animal smoke inhalation model. Burns Incl Therm Inj 16: 409–413CrossRefGoogle Scholar
  46. 46.
    Guha SC, Herndon DN, Evans MJ, et al (1993) Is the CD18 adhesion complex of polymorphonuclear leukocytes involved in smoke-induced lung damage? A morphometric study. J Burn Care Rehabil 14: 503–511PubMedCrossRefGoogle Scholar
  47. 47.
    Smith CW, Marlin SD, Rothlein R, Toman C, Anderson DC (1989) Cooperative interactions of LFA-1 and Mac-1 with intercellular adhesion molecule-1 in facilitating adherence and transendothelial migration of human neutrophils in vitro. J Clin Invest 83: 2008–2017PubMedCrossRefGoogle Scholar
  48. 48.
    Cox CS, Zwischenberger JB, Traber DL, Traber LD, Haque AK, Herndon DN (1993) Heparin improves oxygenation and minimizes barotrauma after severe smoke inhalation in an ovine model. Surg Gynecol Obstet 176: 339–349PubMedGoogle Scholar
  49. 49.
    Nelson RM, Cecconi O, Roberts WG, Aruffo A, Linhardt RJ, Bevilacqua MP (1993) Heparin oligosaccharides bind L- and P-selectin and inhibit acute inflammation. Blood 82: 3253–3258PubMedGoogle Scholar
  50. 50.
    Kimura R, Mlcak R, Richardson J, et al (1988) Treatment of smoke-induced pulmonary injury with nebulized dimethylsulfoxide. Circ Shock 25: 333–341PubMedGoogle Scholar
  51. 51.
    Niehaus GD, Kimura R, Traber LD, Herndon DN, Flynn JT, Traber DL (1990) Administration of a synthetic antiprotease reduces smoke-induced lung injury. J Appl Physiol 69: 694–699PubMedGoogle Scholar
  52. 52.
    Aikawa N, Shinozawa Y, Ishibiki K, et al (1987) Clinical analysis of multiple organ failure in burned patients. Burns Incl Therm Inj 13: 103–109PubMedCrossRefGoogle Scholar
  53. 53.
    Navar PD, Saffle JR, Warden GD (1985) Effect of inhalation injury on fluid resuscitation requirements after thermal injury. Am J Surg 150: 716–720PubMedCrossRefGoogle Scholar
  54. 54.
    Montero K, Lübbesmeyer HJ, Traber DL, Kimura R, Traber LD, Herndon DN (1987) Inhalation injury increases systemic microvascular permeability. Surg Forum 38: 303–305Google Scholar
  55. 55.
    Morris SE, Navaratnam N, Herndon DN (1990) A comparison of effects of thermal injury and smoke inhalation on bacterial translocation. J Trauma 30: 639–643PubMedGoogle Scholar
  56. 56.
    Sugi K, Theissen JL, Traber LD, Herndon DN, Traber DL (1990) Impact of carbon monoxide on cardiopulmonary dysfunction after smoke inhalation injury. Circ Res 66: 69–75PubMedGoogle Scholar
  57. 57.
    Demling RH, LaLonde C (1990) Moderate smoke inhalation produces decreased oxygen delivery, increased oxygen demands, and systemic but not lung parenchymal lipid peroxidation. Surgery 108: 544–552PubMedGoogle Scholar
  58. 58.
    Granger DN (1988) Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury. Am J Physiol 255: H1269–H1275PubMedGoogle Scholar
  59. 59.
    Haglind E, Bengtsson JP, Falk A, Haglund U, Lundgren O, Schersten T (1986) Intestinal vascular obstruction in the cat. Right heart function in a shock model. Res Exp Med (Berl) 186: 285–294CrossRefGoogle Scholar
  60. 60.
    Kadowitz PJ, Hyman AL (1984) Analysis of responses to leukotriene D4 in the pulmonary vascular bed. Circ Res 55: 707–717PubMedGoogle Scholar
  61. 61.
    Noonan TC, Malik AB (1986) Pulmonary vascular response to leukotriene D4 in unanesthetized sheep: Role of thromboxane. J Appl Physiol 60: 765–769PubMedGoogle Scholar
  62. 62.
    Jin LJ, LaLonde C, Demling RH (1986) Lung dysfunction after thermal injury in relation to prostanoid and oxygen radical release. J Appl Physiol 61: 103–112PubMedGoogle Scholar
  63. 63.
    Hüttemeier PC, Watkins WD, Peterson MB, Zapol WM (1982) Acute pulmonary hypertension and lung thromboxane release after endotoxin infusion in normal and leukopenic sheep. Circ Res 50: 688–694PubMedGoogle Scholar
  64. 64.
    Klausner JM, Anner H, Paterson IS, et al (1988) Lower torso ischemia-induced lung injury is leukocyte dependent. Ann Surg 208: 761–767PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • D. L. Traber
  • L. D. Traber

There are no affiliations available

Personalised recommendations