Adult respiratory distress syndrome : an aspect of multiple organ failure : results of a prospective clinical study

l. A. STURM In modern society, trauma remains the number one cause of death in people under 50 years, but, despite this, very little attention has been paid to trauma care compared with other diseases such as malignancy or myocardial infarction (Table 1). The efforts that have been made in medical care, however, have showed some success; for example although the frequency of traffic accidents in the Federal Republic of Germany has remained constant over the years, the number of deaths resulting from them has decreased (Fig. 1). The results of improvements in rescue systems, surgical techniques, and intensive care are evident, as shown by a review of the statistics of about 3000 multiple trauma patients treated in the last 15 years at the trauma de­ partment of Hannover Medical School which reflects the progress that has been made in medical care. After the problem posed by posttraumatic kidney failure had been solved in the 1960s and 1970s, the adult respiratory distress syndrome (ARDS) became the biggest problem in the 1970s and 1980s (Fig. 2). ARDS as a single entity disappeared in the literature in the early 1980s and was replaced by the so-called multiple organ failure (MOF) syndrome. Between 1985 and 1990 35% of the patients in our intensive care unit developed MOF, and 70% of them died. Overall MOF mortality has remained constant since 1985 at about 20% (Fig. 3). Front Matter....Pages I-IX Introduction....Pages 1-4 Front Matter....Pages 5-5 Study Protocol....Pages 7-10 Extravascular Lung Water: Clinical Methodology....Pages 11-16 Bronchoalveolar Lavage....Pages 17-21 Morphometric Description of the Study Population....Pages 22-24 Development of a Linear Scoring System....Pages 25-29 Clinical Definition of ARDS An Index Based on Bedside-Derived Parameters....Pages 30-33 Treatment and Clinical Course....Pages 34-44 Progressive Organ Failure....Pages 45-56 Front Matter....Pages 57-57 Adult Respiratory Distress Syndrome and Complement: Significance of C3a in Diagnosis and Prognosis....Pages 59-74 Differences in Activation of Coagulation and Fibrinolysis After Polytrauma with Respect to the Development of Adult Respiratory Distress Syndrome....Pages 75-87 Front Matter....Pages 89-89 Nonspecific Immune System, Plasma Proteins and Characteristics of the Erythrocyte Insulin Receptor....Pages 91-127 Morphological and Functional Changes of Alveolar Cells....Pages 128-134 Functional Changes in Polymorphonuclear Leukocyte Function Following Severe Polytraumatization....Pages 135-155 Changes in Reticuloendothelial Capacity Associated with Liver Dysfunction in Multiple Trauma....Pages 156-167 CD3 + , CD4 + , CD8 + and B Lymphocyte Numbers in Blood and Bronchoalveolar Lavage Fluid from Trauma Patients with and without ARDS....Pages 168-173 Front Matter....Pages 175-175 Role of Leukotrienes in the Pathophysiology of ARDS After Polytrauma....Pages 177-192 Specific Proteins of Inflammatory Cells and α1-Proteinase Inhibitor in Alveolar Epithelial Lining Fluid of Polytraumatized Patients: Do They Indicate Posttraumatic Lung Failure?....Pages 193-211 Front Matter....Pages 213-213 Plasma and Bronchoalveolar Lavage Fluid Proteins as Markers of Increased Lung Permeability in ARDS as a Result of Multiple Trauma....Pages 215-229 Lung Capillary Leak After Severe Trauma: A Prospective Clinical Study....Pages 230-244 Front Matter....Pages 213-213 Alveolar Surfactant Function in Severely Injured Patients....Pages 245-256 Adult Respiratory Distress Syndrome As a Manifestation of a General Permeability Defect....Pages 257-264 Early and Late Ultrastructural Changes in the Lungs of Patients Suffering from Severe Polytrauma....Pages 265-277 Front Matter....Pages 279-279 Simultaneous Measurement of Endothelial Cell Damage, Elastase Release, and Chemiluminescence Response During Interaction Between Polymorphonuclear Leukocytes and Endothelial Cells....Pages 281-293 Influence of Short- and Long-Term Endotoxin Administration on the Phagocytic Functions of Polymorphonuclear Leukocytes and Reticuloendothelial System in a Sheep Model....Pages 294-307 The Three-Compartment Model in Sheep: The Effect of Recurrent Endotoxemia on Endothelial and Epithelial Permeability in the Lung....Pages 308-320 Bacterial Toxins and Terminal Complement Complex: Significance for Lung Microvascular Injury....Pages 321-339 Back Matter....Pages 341-347 The results of a six-year multicenter study on the pathogenesis of posttraumatic adult respiratory distress syndrome (ARDS) are presented in this volume. The study is unique in that it investigates almost all important mediator and cell system changes and functions with close reference to clinical findings. It becomes apparent in this study that posttraumatic lung failure is one aspect of generalized organ dysfunction. In contrast to findings in the literature, definite organ damage is here demonstrated to occur initially after trauma and not related to a posttraumatic septic reaction after several days. In addition to the clinical study, data on pathobiochemical changes and immune response for the same time intervals are recorded. By comparing the data and pathophysiological interactions, new ways of treating posttraumatic organ damage can be developed.