In:
Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 87, No. 1S ( 2019-7), p. S91-S100
Abstract:
Smoke inhalation injury (SII) causes 30% to 40% mortality and will increase as a cause of death during prolonged field care. We used a combat relevant model of acute respiratory distress syndrome due to SII to study temporal changes in ventilation-perfusion (V/Q) matching, computed tomography (CT) scan data, and histopathology and hypothesized that SII leads to increase in shunt (Q shunt ), V/Q mismatch, lung consolidation, and diffuse alveolar damage. METHODS Swine received severe SII and airway pressure release ventilation (APRV, n = 6), or conventional ARDSNet mechanical ventilation (MV) (CMV, n = 8). A control group without injury received volume controlled MV (CTRL, n = 6), The multiple inert gas elimination technique and CT were performed at baseline (BL), 0.5 hours, 1 hours, 2 hours, 24 hours, and 48 hours after injury. Diffuse alveolar damage scoring was performed post mortem. Significance at p less than 0.05: APRV versus CTRL ‡ ; CMV versus CTRL † ; APRV versus CMV*; & denotes changes versus BL. RESULTS (1) SII caused increases in Q shunt more so in APRV than CMV group. Q shunt did not change in CTRL. (2) Pa o 2 -to-FIO 2 ratio (PFR) was lower in APRV versus CTRL at 2 hours (375 ± 62‡ vs. 549 ± 40) and 24 hours (126 ± 34‡* & vs. 445 ± 5) and 48 hours (120 ± 41‡ & vs. 430 ± 13). In CMV animals, PFR was lower versus CTRL and BL at 24 hours (238 ± 33 † & ) and 48 hours (98 ± 27 † & ). Q shunt correlated with PFR ( r = 0.75, p 〈 0.0001, APRV and ( r = 0.65, p 〈 0.0001, CMV). CT showed decrease in normally aerated lung, while poorly and nonaerated lung increased. CONCLUSION Smoke inhalation injury leads to early development of shunt, V/Q mismatch, lung consolidation, and diffuse alveolar damage. These data substantiate the need for new point of injury interventions in the prolonged field care setting. LEVEL OF EVIDENCE Animal research.
Type of Medium:
Online Resource
ISSN:
2163-0763
,
2163-0755
DOI:
10.1097/TA.0000000000002227
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2651313-4
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