Posttraumatic Lung Injury After Pulmonary Contusion and Fat Embolism: Factors Determining Abnormal Gas Exchange

Whelan, Daniel B.; Byrick, Robert J.; Mazer, C. David; Kay, Colin; Richards, Robin R.; Zdero, Rad; Schemitsch, Emil H.

doi:10.1097/ta.0b013e3181ec484f

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…The pathological results indicated that intramedullary procedures were able to evoke PFE, which mainly resulted in a reduced PaO 2 and an increased PaCO 2 during surgery. Similar results have been identified in other studies (6,23). A potential reason for the induction of PFE may be that a fat embolus entered the lung, which decreased the blood perfusion and exchange area, and subsequently increased the dead space area.…”

Section: Discussionsupporting

confidence: 93%

Pulmonary fat embolism and related effects during femoral intramedullary surgery: An experimental study in dogs

Zhou

Song

et al. 2013

Experimental and Therapeutic Medicine

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The aim of the present study was to develop an animal model of pulmonary fat embolism (PFE) caused by femoral intramedullary procedures, and to investigate the initial changes in the hemodynamics, cytokines and risk factors of PFE. Sixteen dogs were randomly divided into two groups: Group A (intramedullary reaming and bone cement injection, n=8) and Group B (surgical approach without opening the medullary cavity, n=8). The hemodynamics, arterial blood gases and relevant cytokines were evaluated, and the lungs were examined using Oil Red O staining. In the animals of Group A, the heart rate, central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and extravascular lung water (EVLW) were increased compared with the baseline levels, while the mean arterial pressure was decreased immediately following the reaming and bone cement infusion (P<0.05). Furthermore, there was a significant reduction in the pH and the arterial oxygen tension (PaO2), and a significant increase in the arterial carbon dioxide tension (PaCO2; P<0.05 for all) following the bilateral intramedullary surgery. The EVLW was correlated with the PaO2 (P<0.001) and PaCO2 (P=0.046). Following surgery, there was a significant increase in tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and IL-6 levels in Group A (P<0.05). However, there were no significant changes in these parameters in Group B. The parameters tested, with the exception of pH, were significantly different in Group A compared with those in Group B (P<0.05) following the bilateral intramedullary surgery. Oil Red O staining was positive for all animals in Group A and negative for those in Group B. Femoral intramedullary surgery may induce PFE and subsequently affect hemodynamics and arterial blood gases. EVLW was correlated with the PaO2 (P<0.001) and the PaCO2 (P=0.046). These results demonstrated that EVLW and cytokines may serve as predictors of the development of fat embolism syndrome (FES).

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Section: Discussionsupporting

confidence: 93%

Pulmonary fat embolism and related effects during femoral intramedullary surgery: An experimental study in dogs

Zhou

Song

et al. 2013

Experimental and Therapeutic Medicine

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“…13 Increased severity of lung contusions was proportional to is straightforward with a decrease in cardiac output which will interfere with the O2 and CO2 gas exchange system in the alveolus. 14 Respiratory failure results from a decrease in surfactant during the first 30 minutes of pulmonary contusions followed by a secondary inflammatory response in cases of unilateral pulmonary contusions. 15 Thoracic trauma with <3 rib fractures accounted for 30 patients or 81.1% of the total cases followed by thoracic trauma with 3-5 rib fractures (13.5%) and thoracic trauma with> 5 rib fractures (5.4%).…”

Section: Discussionmentioning

confidence: 99%

Chest Trauma Score of Thoracic Trauma Patients in Dr. Mohammad Hoesin Palembang January-June 2020

Marrantiza¹,

Umar

Bermansyah

et al. 2021

sjs

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Introduction: Thoracic trauma has mortality rates varying from 10% to 60%. Various scoring frameworks have been created for prognostic value in thoracic trauma patients, including the chest trauma score (CTS). This has not been studied in Indonesian patients. The authors decided to study the picture of CTS in thoracic trauma patients in the Indonesian subpopulation, especially in our hospital. Methods: This research is an analytical observational study at dr. Mohammad Hoesin (RSMH) Palembang in January-June 2020. Our research variables are age, lung contusions, number of rib fractures, bilateral rib fractures, and Chest Trauma Score (CTS). 37 cases could be analyzed with the length of stay, ICU care, mortality, and surgery option. Results: The most common thoracic trauma occurred at the age between less than 45 years, the highest degree of lung contusions was unilateral minor lung contusions. The most common rib fractures were <3 rib fractures. Chest Trauma Score in this study were less than 5. The CTS score had a significant relationship with length of stay and the need of ICU, but was not significantly associated with mortality and surgery option. Conclusion: Chest trauma score can be used to consider the length of treatment and priority needs of the ICU which will be prepared for the management of thoracic trauma patients, especially the young who are accompanied by lung contusions and rib fractures.

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“…Dogs were randomly assigned to the supine position or the lateral position group [Figure 1]. Group size was determined based on the authors’ financial constraints for this study, the practical limitations of animal care provided by the authors’ institution and the methodology of the authors’ prior dog studies 11122728. A standard anesthetic protocol was used with a respirator and paralyzing anesthesia.…”

Section: Methodsmentioning

confidence: 99%

The effect of patient position during trauma surgery on fat embolism syndrome: An experimental study

Syed

Blankstein

Bhandari

et al. 2014

IJOO

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Background:The aim of this study was to compare the effect of supine versus lateral position on clinical signs of fat embolism during orthopedic trauma surgery. Dogs served as the current study model, which could be extended and/or serve as a basis for future in vivo studies on humans. It was hypothesized that there would be an effect of position on clinical signs of fat embolism syndrome in a dog model.Materials and Methods:12 dogs were assigned to supine (n = 6) and lateral (n = 6) position groups. Airway pressures, heart rate, blood pressure, cardiac output, pulmonary artery pressure, pulmonary artery wedge pressure, right atrial pressure, arterial and venous blood gases, white blood count, platelet count and neutrophil count were obtained. Dogs were then subjected to pulmonary contusion in three areas of one lung. Fat embolism was generated by reaming one femur and tibia, followed by pressurization of the canal.Results:No difference was found in any parameters measured between supine and lateral positions at any time (0.126 < P < 0.856).Conclusions:The position of trauma patients undergoing reamed intramedullary nailing did not alter the presentation of the features of the lung secondary to fat embolism.

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Posttraumatic Lung Injury After Pulmonary Contusion and Fat Embolism: Factors Determining Abnormal Gas Exchange

Abstract: Gas exchange deteriorates because of decreased CO. For any preexisting intrapulmonary shunt, the decrease of PvO2 will cause worsening of Pao2.

Cited by 5 publications

References 22 publications

Pulmonary fat embolism and related effects during femoral intramedullary surgery: An experimental study in dogs

Pulmonary fat embolism and related effects during femoral intramedullary surgery: An experimental study in dogs

Chest Trauma Score of Thoracic Trauma Patients in Dr. Mohammad Hoesin Palembang January-June 2020

The effect of patient position during trauma surgery on fat embolism syndrome: An experimental study

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