Sequential patterns of eicosanoid, platelet, and neutrophil interactions in the evolution of the fulminant post-traumatic adult respiratory distress syndrome.

摘要: Thirty multiply injured blunt-trauma patients at high risk for development of ARDS (multisystem trauma including more than one organ or extremity, Injury Severity Score 26 more, hypotension and need 1500 mL blood within the first hour after admission, PaO2 less equal to 70 torr) were studied sequentially with physiologic evaluations beginning immediately injury every eight hours days, until death, study evolution process. Mixed venous samples obtained eicosanoids PGE2, PGF2 alpha, thromboxane B2, PGI2 (6-KetoPGF1 alpha) leukotriene B4 (LTB4). Platelet (PLAT), neutrophil (WBC) counts also done plasma elastase was measured. At 7:00 AM each day patient neutrophils a zymosan-activated superoxide production using chemiluminescence assay. These data correlated measurements Respiratory Index (RI), per cent pulmonary shunt (QS/QT), respiratory compliance measures. Seven developed fulminant post-traumatic syndrome 96 injury. Twelve without sepsis (TS) four days injury, 11 had uncomplicated postinjury courses (TR). Compared both TR TS, significant (p 0.01) rise in on 2 through 4 This preceded by rises PGE2 LTB4, which significantly subsequent falls PLAT WBC TXB2, PGF1, followed increases RI, QS/QT, fall compliance. The difference pattern sequence events compared TS suggests that earliest event may be related peripheral release LTB4 due platelet activation lung sequestration aggregation leukocyte adherence elastase. However, mortality appears amplification does not achieve significance before second maximum suggest post-trauma follows different evolutionary reported animal models is from seen human patients.(ABSTRACT TRUNCATED AT 400 WORDS)