We prospectively studied the variation in sequence of occurrence of lung microvascular permeability (LMVP) increase and clinical onset of posttraumatic acute lung failure (ALF) in the sequential failure of organ systems after direct and indirect lung injury. Acute lung failure developed in 52 of 255 trauma patients. Thirty-seven of these developed ALF after a direct injury to lung tissue and 11 after an indirect injury. Lung microvascular permeability was measured with a gamma camera simultaneously over both lungs using indium 113m-labeled transferring and technetium 99m-labeled erythrocytes in 24 patients with ALF due to direct lung injury and in 4 with ALF due to indirect injury. A localized increased LMVP was observed initially only in the directly traumatized lung (traumatized/nontraumatized lung: 10.03 ± 5.08/3.73 ± 3.33 %/h), but involved the primarily nontraumatized lung within 4 days (traumatized/nontraumatized lung: 9.13 ± 4.49/10.89 5 ± 5.05 %/h). In contrast, in ALF due to indirect lung injury, an increased LMVP over both lungs was observed initially (right/left lung: 11.57 ± 6.18/12.63 ± 5.73 %/h) and 4 days later (right/left lung: 12.3 ± 5.49/11.92 ± 5.75 %/h). Acute lung failure due to direct lung injury occurred significantly earlier (<72 h) (P < 0.01), whereas onset of indirectly induced ALF was later (>72 h). Sepsis syndrome and multiple organ failure were the major complications once ALF occurred after a direct injury. In contrast, sepsis syndrome and multiple organ failure commonly preceded or paralleled the onset of ALF due to an indirect injury. Our data suggest that direct and indirect injuries to lung tissue determine the temporal sequence of changes in LMVP, which in turn is related to a different clinical onset of ALF in the sequential failure of organ systems.
Address correspondence to Dr. Putensen, Klinik für Anaesthesie und Allgemeine lntensivmedizin Anichstrasse 35, A-6020, Innsbruck, Austria. Currently Department of Anesthesiology, College of Medicine, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC Box 59, Tampa, FL 33612-4799.
© 1992 International Anesthesia Research Society