Skip to main content
NCBI home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1988 Jan;148(1):33–36.

New Developments in the Pathogenesis of Smoke Inhalation-Induced Pulmonary Edema

Mark L Witten, Stuart F Quan, Richard E Sobonya, Richard J Lemen
PMCID: PMC1026006  PMID: 3277334

Abstract

Smoke inhalation causes most of the deaths in fire-related injuries, with pulmonary edema as a major determinant in the outcome of smoke-inhalation injury. The pathophysiology of pulmonary edema is thought to be related to the products of incomplete combustion. Damage to the integrity of the alveolar epithelium is one of the determinants of the development of smoke-induced pulmonary edema. In recent studies using lung clearance of aerosolized pentetic acid (DTPA [diethylenetriaminepentaacetic acid]) labeled with technetium Tc 99m to assess the permeability of the alveolar epithelium, several factors were identified that may increase a person's susceptibility to smoke-induced acute lung injury. These are increased initial alveolar permeability and alterations in the number and activity of alveolar macrophages. Clinical measurement of 99mTcDTPA clearance may provide a sensitive and convenient method for the early detection and serial assessment of smoke-induced alveolar epithelial permeability changes.

Full text

PDF
33

Images in this article

34Image
on p.34

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Czer G. T., Marsh J., Konopka R., Moser K. M. Low-dose PGI2 prevents monocrotaline-induced thromboxane production and lung injury. J Appl Physiol (1985) 1986 Feb;60(2):464–471. doi: 10.1152/jappl.1986.60.2.464. [DOI] [PubMed] [Google Scholar]
  2. Dyer R. F., Esch V. H. Polyvinyl chloride toxicity in fires. Hydrogen chloride toxicity in fire fighters. JAMA. 1976 Jan 26;235(4):393–397. [PubMed] [Google Scholar]
  3. Fein A., Leff A., Hopewell P. C. Pathophysiology and management of the complications resulting from fire and the inhaled products of combustion: review of the literature. Crit Care Med. 1980 Feb;8(2):94–98. doi: 10.1097/00003246-198002000-00008. [DOI] [PubMed] [Google Scholar]
  4. Ford-Hutchinson A. W. Leukotrienes: their formation and role as inflammatory mediators. Fed Proc. 1985 Jan;44(1 Pt 1):25–29. [PubMed] [Google Scholar]
  5. Hartiala J., Mapp C., Mitchell R. A., Shields R. L., Gold W. M. Cigarette smoke-induced bronchoconstriction in dogs: vagal and extravagal mechanisms. J Appl Physiol Respir Environ Exerc Physiol. 1984 Oct;57(4):1261–1270. doi: 10.1152/jappl.1984.57.4.1261. [DOI] [PubMed] [Google Scholar]
  6. Jefferies A. L., Coates G., O'Brodovich H. Pulmonary epithelial permeability in hyaline-membrane disease. N Engl J Med. 1984 Oct 25;311(17):1075–1080. doi: 10.1056/NEJM198410253111703. [DOI] [PubMed] [Google Scholar]
  7. Jones J. G., Minty B. D., Lawler P., Hulands G., Crawley J. C., Veall N. Increased alveolar epithelial permeability in cigarette smokers. Lancet. 1980 Jan 12;1(8159):66–68. doi: 10.1016/s0140-6736(80)90493-6. [DOI] [PubMed] [Google Scholar]
  8. Loke J., Paul E., Virgulto J. A., Smith G. J. Rabbit lung after acute smoke inhalation. Cellular responses and scanning electron microscopy. Arch Surg. 1984 Aug;119(8):956–959. doi: 10.1001/archsurg.1984.01390200074017. [DOI] [PubMed] [Google Scholar]
  9. Malik A. B., Perlman M. B., Cooper J. A., Noonan T., Bizios R. Pulmonary microvascular effects of arachidonic acid metabolites and their role in lung vascular injury. Fed Proc. 1985 Jan;44(1 Pt 1):36–42. [PubMed] [Google Scholar]
  10. Markley K. Burn care: infection and smoke inhalation. Ann Intern Med. 1979 Feb;90(2):269–270. doi: 10.7326/0003-4819-90-2-269. [DOI] [PubMed] [Google Scholar]
  11. Mason G. R., Uszler J. M., Effros R. M., Reid E. Rapidly reversible alterations of pulmonary epithelial permeability induced by smoking. Chest. 1983 Jan;83(1):6–11. doi: 10.1378/chest.83.1.6. [DOI] [PubMed] [Google Scholar]
  12. Meignan M., Rosso J., Robert R. Lung epithelial permeability to aerosolized solutes: relation to position. J Appl Physiol (1985) 1987 Mar;62(3):902–911. doi: 10.1152/jappl.1987.62.3.902. [DOI] [PubMed] [Google Scholar]
  13. Mellins R. B. Respiratory complications of smoke inhalation in victims of fires. J Pediatr. 1975 Jul;87(1):1–7. doi: 10.1016/s0022-3476(75)80059-x. [DOI] [PubMed] [Google Scholar]
  14. Minty B. D., Royston D. Cigarette smoke induced changes in rat pulmonary clearance of 99mTcDTPA. A comparison of particulate and gas phases. Am Rev Respir Dis. 1985 Dec;132(6):1170–1173. doi: 10.1164/arrd.1985.132.6.1170. [DOI] [PubMed] [Google Scholar]
  15. Minty B. D., Royston D., Jones J. G., Smith D. J., Searing C. S., Beeley M. Changes in permeability of the alveolar-capillary barrier in firefighters. Br J Ind Med. 1985 Sep;42(9):631–634. doi: 10.1136/oem.42.9.631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Moylan J. A., Jr, Wilmore D. W., Mouton D. E., Pruitt B. A., Jr Early diagnosis of inhalation injury using 133 xenon lung scan. Ann Surg. 1972 Oct;176(4):477–484. doi: 10.1097/00000658-197210000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Moylan J. A. Smoke inhalation and burn injury. Surg Clin North Am. 1980 Dec;60(6):1533–1540. doi: 10.1016/s0039-6109(16)42297-8. [DOI] [PubMed] [Google Scholar]
  18. PHILLIPS A. W., TANNER J. W., COPE O. BURN THERAPY. IV. RESPIRATORY TRACT DAMAGE (AN ACCOUNT OF THE CLINICAL, X-RAY AND POSTMORTEM FINDINGS) AND THE MEANING OF RESTLESSNESS. Ann Surg. 1963 Nov;158:799–811. doi: 10.1097/00000658-196311000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Pruitt B. A., Jr, Erickson D. R., Morris A. Progressive pulmonary insufficiency and other pulmonary complications of thermal injury. J Trauma. 1975 May;15(5):369–379. [PubMed] [Google Scholar]
  20. Rizk N. W., Luce J. M., Hoeffel J. M., Price D. C., Murray J. F. Site of deposition and factors affecting clearance of aerosolized solute from canine lungs. J Appl Physiol Respir Environ Exerc Physiol. 1984 Mar;56(3):723–729. doi: 10.1152/jappl.1984.56.3.723. [DOI] [PubMed] [Google Scholar]
  21. Schall G. L., McDonald H. D., Carr L. B., Capozzi A. Xenon ventilation-perfusion lung scans. The early diagnosis of inhalation injury. JAMA. 1978 Nov 24;240(22):2441–2445. [PubMed] [Google Scholar]
  22. Smoke inhalation. West J Med. 1981 Oct;135(4):300–309. [PMC free article] [PubMed] [Google Scholar]
  23. Starling M. B., Neutze J. M., Hill D. G., Jagusch M., Cleland J. F., Johns A., Elliott R. L. The effects of prostacyclin (PGI2) on haematological and haemodynamic parameters, and lung histology in puppies undergoing cardiopulmonary bypass surgery with profound hypothermia. Prostaglandins Leukot Med. 1985 Jan;17(1):11–29. doi: 10.1016/0262-1746(85)90030-7. [DOI] [PubMed] [Google Scholar]
  24. Staub N. C., Schultz E. L., Koike K., Albertine K. H. Effect of neutrophil migration induced by leukotriene B4 on protein permeability in sheep lung. Fed Proc. 1985 Jan;44(1 Pt 1):30–35. [PubMed] [Google Scholar]
  25. Teixidor H. S., Novick G., Rubin E. Pulmonary complications in burn patients. J Can Assoc Radiol. 1983 Dec;34(4):264–270. [PubMed] [Google Scholar]
  26. Teixidor H. S., Rubin E., Novick G. S., Alonso D. R. Smoke inhalation: radiologic manifestations. Radiology. 1983 Nov;149(2):383–387. doi: 10.1148/radiology.149.2.6622680. [DOI] [PubMed] [Google Scholar]
  27. Traber D. L., Herndon D. N., Stein M. D., Traber L. D., Flynn J. T., Niehaus G. D. The pulmonary lesion of smoke inhalation in an ovine model. Circ Shock. 1986;18(4):311–323. [PubMed] [Google Scholar]
  28. Trunkey D. D. Inhalation injury. Surg Clin North Am. 1978 Dec;58(6):1133–1140. doi: 10.1016/s0039-6109(16)41681-6. [DOI] [PubMed] [Google Scholar]
  29. WIDDICOMBE J. G., KENT D. C., NADEL J. A. Mechanism of bronchoconstriction during inhalation of dust. J Appl Physiol. 1962 Jul;17:613–616. doi: 10.1152/jappl.1962.17.4.613. [DOI] [PubMed] [Google Scholar]
  30. Walker H. L., McLeod C. G., Jr, McManus W. F. Experimental inhalation injury in the goat. J Trauma. 1981 Nov;21(11):962–964. doi: 10.1097/00005373-198111000-00009. [DOI] [PubMed] [Google Scholar]
  31. Whitener D. R., Whitener L. M., Robertson K. J., Baxter C. R., Pierce A. K. Pulmonary function measurements in patients with thermal injury and smoke inhalation. Am Rev Respir Dis. 1980 Nov;122(5):731–739. doi: 10.1164/arrd.1980.122.5.731. [DOI] [PubMed] [Google Scholar]
  32. Witten M. L., Lemen R. J., Quan S. F., Sobonya R. E., Magarelli J. L., Bruck D. C. Acute cigarette smoke exposure causes lung injury in rabbits treated with ibuprofen. Exp Lung Res. 1987;13(2):113–126. doi: 10.3109/01902148709064313. [DOI] [PubMed] [Google Scholar]
  33. Witten M. L., Lemen R. J., Quan S. F., Sobonya R. E., Roseberry H., Stevenson J. L., Clayton J. Acute cigarette smoke exposure increases alveolar permeability in rabbits. Am Rev Respir Dis. 1985 Aug;132(2):321–325. doi: 10.1164/arrd.1985.132.2.321. [DOI] [PubMed] [Google Scholar]
  34. Zikria B. A., Ferrer J. M., Floch H. F. The chemical factors contributing to pulmonary damage in "smoke poisoning". Surgery. 1972 May;71(5):704–709. [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES