Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1980 Jul;192(1):95–102. doi: 10.1097/00000658-198007000-00016

Pulmonary gas exchange abnormalities following intravascular coagulation. Reticuloendothelial involvement.

P R Schumacker, T M Saba
PMCID: PMC1344812  PMID: 6773482

Abstract

The influence of reticuloendothelial (RE) blockade on the pulmonary hemodynamic and gas exchange response to thrombin induced low-grade intravascular coagulation was studied in dogs during fibrinolytic inhibition. Neither saline infusion nor experimentally induced RE blockade significantly increased pulmonary vascular resistance, physiologic dead space, or pulmonary venous admixture. Intravascular coagulation in the absence of RE blockade resulted in a significant (p less than 0.05) elevation in pulmonary vascular resistance which was transient and returned to prechallenge levels over a two to four hour period. This response was not associated with any significant change in physiological dead space. In contrast, intravascular coagulation in the presence of RE blockade resulted in significant (p less than 0.05) hemodynamic and gas exchange abnormalities. These included an acute elevation in pulmonary vascular resistance, a decrease in arterial oxygenation, an increase in pulmonary venous admixture, and a sustained elevation in physiologic dead space. These events were associated with an elevation in the lung wet-to-dry weight ratios. Gas exchange and hemodynamic alterations afterthrombin infusion during RE blockade suggest a functional role for the reticuloendothelial system in the prevention of pulmonary injury during intravascular coagulation. Thus, this study suggests a possible role of the RES in minimizing pulmonary injury during states of increased microaggregate formation.

Full text

PDF
95

Selected References

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

  1. Blumenstock F. A., Saba T. M., Weber P. Purification of alpha-2-opsonic protein from human serum and its measurement by immunoassay. J Reticuloendothel Soc. 1978 Feb;23(2):119–134. [PubMed] [Google Scholar]
  2. Busch C., Saldeen T. Amount of fibrin in different organs after intravenous, intraportal and intraaortal injection of thrombin in the rat. Thromb Diath Haemorrh. 1973 Feb 28;29(1):87–93. [PubMed] [Google Scholar]
  3. Cornell R. P., Saba T. M. Bioassay of serum opsonin and its depletion after colloid clearance in dogs. Am J Physiol. 1972 Sep;223(3):569–574. doi: 10.1152/ajplegacy.1972.223.3.569. [DOI] [PubMed] [Google Scholar]
  4. Dantzker D. R., Wagner P. D., Tornabene V. W., Alazraki N. P., West J. B. Gas exchange after pulmonary thromboemoblization in dogs. Circ Res. 1978 Jan;42(1):92–103. doi: 10.1161/01.res.42.1.92. [DOI] [PubMed] [Google Scholar]
  5. Evans J. W., Wagner P. D. Limits on VA/Q distributions from analysis of experimental inert gas elimination. J Appl Physiol Respir Environ Exerc Physiol. 1977 Jun;42(6):889–898. doi: 10.1152/jappl.1977.42.6.889. [DOI] [PubMed] [Google Scholar]
  6. Gans H. Preservation of vascular patency as a function of reticuloendothelial clearance. Surgery. 1966 Dec;60(6):1216–1223. [PubMed] [Google Scholar]
  7. Gans U., Subramanian V., Tan B. H. Selective phagocytosis: a new concept in protein catabolism. Science. 1968 Jan 5;159(3810):107–110. [PubMed] [Google Scholar]
  8. Kaplan J. E., Saba T. M. Humoral deficiency and reticuloendothelial depression after traumatic shock. Am J Physiol. 1976 Jan;230(1):7–14. doi: 10.1152/ajplegacy.1976.230.1.7. [DOI] [PubMed] [Google Scholar]
  9. Kaplan J. E., Saba T. M. Platelet removal from the circulation by the liver and spleen. Am J Physiol. 1978 Sep;235(3):H314–H320. doi: 10.1152/ajpheart.1978.235.3.H314. [DOI] [PubMed] [Google Scholar]
  10. LEE L., McCLUSKEY R. T. Immunohistochemical demonstration of the reticuloendothelial clearance of circulating fibrin aggregates. J Exp Med. 1962 Nov 1;116:611–618. doi: 10.1084/jem.116.5.611. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lee L., Prose P. H., Cohen M. H. The role of the reticuloendothelial system in diffuse, low grade intravascular coagulation. Thromb Diath Haemorrh Suppl. 1966;20:87–95. [PubMed] [Google Scholar]
  12. Lindquist O., Saldeen T., Sandler H. Pulmonary damage following pulmonary microembolism in the dog. Effect of various types of treatment. Acta Chir Scand. 1976;142(1):15–19. [PubMed] [Google Scholar]
  13. Luterman A., Manwaring D., Curreri P. W. The role of fibrinogen degradation products in the pathogenesis of the respiratory distress syndrome. Surgery. 1977 Nov;82(5):703–709. [PubMed] [Google Scholar]
  14. Malik A. B., van der Zee H. Thrombin induced pulmonary insufficiency. Thromb Res. 1977 Oct;11(4):497–506. doi: 10.1016/0049-3848(77)90203-1. [DOI] [PubMed] [Google Scholar]
  15. Nunnelley L. L., Smythe W. R., Alfrey A. C., Ibels L. S. Uremic hyperstannum: elevated tissue tin levels associated with uremia. J Lab Clin Med. 1978 Jan;91(1):72–75. [PubMed] [Google Scholar]
  16. Saba T. M., Blumenstock F. A., Scovill W. A., Bernard H. Cryoprecipitate reversal of opsonic alpha2-surface binding glycoprotein deficiency in septic surgical and trauma patients. Science. 1978 Aug 18;201(4356):622–624. doi: 10.1126/science.675246. [DOI] [PubMed] [Google Scholar]
  17. Saba T. M., Blumenstock F. A., Weber P., Kaplan J. E. Physiologic role of cold-insoluble globulin in systemic host defense: implications of its characterization as the opsonic alpha 2-surface-binding glycoprotein. Ann N Y Acad Sci. 1978 Jun 20;312:43–55. doi: 10.1111/j.1749-6632.1978.tb16792.x. [DOI] [PubMed] [Google Scholar]
  18. Saba T. M., Di Luzio N. R. Reticuloendothelial blockade and recovery as a function of opsonic activity. Am J Physiol. 1969 Jan;216(1):197–205. doi: 10.1152/ajplegacy.1969.216.1.197. [DOI] [PubMed] [Google Scholar]
  19. Saba T. M. Effect of surgical trauma on the clearance and localization of blood-borne particulate matter. Surgery. 1972 May;71(5):675–685. [PubMed] [Google Scholar]
  20. Scovill W. A., Annest S. J., Saba T. M., Blumenstock F. A., Newell J. C., Stratton H. H., Powers S. R. Cardiovascular hemodynamics after opsonic alpha-2-surface binding glycoprotein therapy in injured patients. Surgery. 1979 Aug;86(2):284–293. [PubMed] [Google Scholar]
  21. Severinghaus J. W. Blood gas calculator. J Appl Physiol. 1966 May;21(3):1108–1116. doi: 10.1152/jappl.1966.21.3.1108. [DOI] [PubMed] [Google Scholar]
  22. Tonaki H., Saba T. M., Mayron L. W., Kaplan E. Phagocytosis of gelatinized "R. E. test lipid emulsion" by Kupffer cells: electronmicroscopic observations. Exp Mol Pathol. 1976 Oct;25(2):189–201. doi: 10.1016/0014-4800(76)90029-0. [DOI] [PubMed] [Google Scholar]
  23. Vaage J., Hauge A. Small airway constriction and closure after induced intravascular platelet aggregation. Acta Physiol Scand. 1977 Jun;100(2):221–230. doi: 10.1111/j.1748-1716.1977.tb05940.x. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES