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. 1980 Feb;191(2):171–181. doi: 10.1097/00000658-198002000-00008

The effect of smoke inhalation on pulmonary surfactant.

G F Nieman, W R Clark Jr, S D Wax, S R Webb
PMCID: PMC1345605  PMID: 6892674

Abstract

This paper details efforts to define the primary pathophysiology of acute smoke inhalation without the variables of infection, burns, or fluid resuscitation. A standard dose of smoke (wood and kerosene) was delivered at 37 C to mongrel dogs. The parameters studied included blood gases, carboxyhemoglobin, pulmonary and systemic hemodynamics, respiratory mechanics, surface tension area curves as an indication of surfactant activity, and in vivo photomicroscopy. The FiO2 of the smoke was 17 volumes per cent; the carbon monoxide 17,000 ppm. Immediately following smoke exposure, dense, nonsegmental atelectasis developed. Hemodynamic changes were insignificant, but the PaO2 fell to 49 mmHg; the right to left shunt rose from 5 to 41%. Surfactant reduction was significant: enough to cause an increase in the minimum surface tension from 7 to 22 dynes/cm. This surfactant loss may explain the atelectasis seen and the marked instability of subpleural alveolar walls. The data collected are consistent and support the acute inactivation of surfactant as one of the primary pathophysiologic events in smoke inhalation. The clinical correlation is good; surfactant loss may explain why victims of smoke inhalation are so vulnerable to fluid administration if they have thermal burns as well effectiveness of medical devices.

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Selected References

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

  1. BRUDERMAN I., SOMERS K., HAMILTON W. K., TOOLEY W. H., BUTLER J. EFFECT OF SURFACE TENSION ON CIRCULATION IN THE EXCISED LUNGS OF DOGS. J Appl Physiol. 1964 Jul;19:707–712. doi: 10.1152/jappl.1964.19.4.707. [DOI] [PubMed] [Google Scholar]
  2. Balis J. U., Shelley S. A. Quantitative evaluation of the surfactant system of the lung. Ann Clin Lab Sci. 1972 Sep-Oct;2(5):410–419. [PubMed] [Google Scholar]
  3. Clark W. R., Jr, Webb W. R., Wax S., Nieman G. Inhalation injuries: the pathophysiology of acute smoke inhalation. Surg Forum. 1977;28:177–179. [PubMed] [Google Scholar]
  4. Clements J. A. Pulmonary surfactant. Am Rev Respir Dis. 1970 Jun;101(6):984–990. doi: 10.1164/arrd.1970.101.6.984. [DOI] [PubMed] [Google Scholar]
  5. Dressler D. P., Skornik W. A., Kupersmith S. Corticosteroid treatment of experimental smoke inhalation. Ann Surg. 1976 Jan;183(1):46–52. doi: 10.1097/00000658-197601000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. ENGEL S. The respiratory tissue of the dog. Acta Anat (Basel) 1958;35(4):301–310. doi: 10.1159/000141418. [DOI] [PubMed] [Google Scholar]
  7. Ecanow B., Balagot R. C., Bandelin V. Effect of suspended particles on the gas-absorbing ability of lung surfactants. Am Rev Respir Dis. 1969 Jan;99(1):106–108. doi: 10.1164/arrd.1969.99.1.106. [DOI] [PubMed] [Google Scholar]
  8. FINLEY T. N., TOOLEY W. H., SWENSON E. W., GARDNER R. E., CLEMENTS J. A. PULMONARY SURFACE TENSION IN EXPERIMENTAL ATELECTASIS. Am Rev Respir Dis. 1964 Mar;89:372–378. doi: 10.1164/arrd.1964.89.3.372. [DOI] [PubMed] [Google Scholar]
  9. Goerke J. Lung surfactant. Biochim Biophys Acta. 1974 Dec 16;344(3-4):241–261. doi: 10.1016/0304-4157(74)90009-4. [DOI] [PubMed] [Google Scholar]
  10. Greenfield L. J., Chernick V., Hodson W. A., Brumley G. W. Alterations in pulmonary surfactant following compression atelectasis, pulmonary artery ligation, and reimplantation of the lung. Ann Surg. 1967 Jul;166(1):109–117. doi: 10.1097/00000658-196707000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Henry J. N. The effect of shock on pulmonary alveolar surfactant. Its role in refractory respiratory insufficiency of the critically ill or severely injured patient. J Trauma. 1968 Sep;8(5):756–773. [PubMed] [Google Scholar]
  12. King R. J. The surfactant system of the lung. Fed Proc. 1974 Nov;33(11):2238–2247. [PubMed] [Google Scholar]
  13. LEVINE B. E., JOHNSON R. P. SURFACE ACTIVITY OF SALINE EXTRACTS FROM INFLATED AND DEGASSED NORMAL LUNGS. J Appl Physiol. 1964 Mar;19:333–335. doi: 10.1152/jappl.1964.19.2.333. [DOI] [PubMed] [Google Scholar]
  14. LLOYD T. C., Jr, WRIGHT G. W. Pulmonary vascular resistance and vascular transmural gradient. J Appl Physiol. 1960 Mar;15:241–245. doi: 10.1152/jappl.1960.15.2.241. [DOI] [PubMed] [Google Scholar]
  15. MEAD J. Mechanical properties of lungs. Physiol Rev. 1961 Apr;41:281–330. doi: 10.1152/physrev.1961.41.2.281. [DOI] [PubMed] [Google Scholar]
  16. MILLER D., BONDURANT S. Effects of cigarette smoke on the surface characteristics of lung extracts. Am Rev Respir Dis. 1962 May;85:692–696. doi: 10.1164/arrd.1962.85.5.692. [DOI] [PubMed] [Google Scholar]
  17. Mallory T. B., Brickley W. J. PATHOLOGY: WITH SPECIAL REFERENCE TO THE PULMONARY LESIONS. Ann Surg. 1943 Jun;117(6):865–884. doi: 10.1097/00000658-194311760-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Mead J., Takishima T., Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol. 1970 May;28(5):596–608. doi: 10.1152/jappl.1970.28.5.596. [DOI] [PubMed] [Google Scholar]
  19. Monafo W. W., Robinson H. N., Yoshioka T., Ayvazian V. H. 'Lethal' burns. A progress report. Arch Surg. 1978 Apr;113(4):397–401. doi: 10.1001/archsurg.1978.01370160055007. [DOI] [PubMed] [Google Scholar]
  20. Morgan T. E. Pulmonary surfactant. N Engl J Med. 1971 May 27;284(21):1185–1193. doi: 10.1056/NEJM197105272842105. [DOI] [PubMed] [Google Scholar]
  21. Moritz A. R., Henriques F. C., McLean R. The Effects of Inhaled Heat on the Air Passages and Lungs: An Experimental Investigation. Am J Pathol. 1945 Mar;21(2):311–331. [PMC free article] [PubMed] [Google Scholar]
  22. NASH C. B., DAVIS F., WOODBURY R. A. Cardiovascular effects of anesthetic doses of pentobarbital sodium. Am J Physiol. 1956 Apr;185(1):107–112. doi: 10.1152/ajplegacy.1956.185.1.107. [DOI] [PubMed] [Google Scholar]
  23. Neville J. F., Jr, Askanazi J., Kane P. B., Webb W. R. Airway resistance regulation of dynamic compliance. Surgery. 1974 Jul;76(1):65–71. [PubMed] [Google Scholar]
  24. Neville J. F., Jr, Askanazi J., Mon R. L., Kane P. B., Hanson E. L., Webb W. R. Determinants of pulmonary artery wedge pressure. Surg Forum. 1975;26:206–208. [PubMed] [Google Scholar]
  25. PHILLIPS A. W., COPE O. Burn therapy. II. The revelation of respiratory tract damage as a principal killer of the burned patient. Ann Surg. 1962 Jan;155:1–19. doi: 10.1097/00000658-196201000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Pontoppidan H., Geffin B., Lowenstein E. Acute respiratory failure in the adult. 2. N Engl J Med. 1972 Oct 12;287(15):743–752. doi: 10.1056/NEJM197210122871505. [DOI] [PubMed] [Google Scholar]
  27. Rosenberg E. Analysis of the properties of pulmonary surfactant using modified Wilhelmy balances. Respir Physiol. 1969 Jun;7(1):72–87. doi: 10.1016/0034-5687(69)90070-x. [DOI] [PubMed] [Google Scholar]
  28. Schuurmans Stekhoven J. H., Kreuzer F. Shunt component of alveolar-arterial oxygen pressure difference and atelectasis. Respir Physiol. 1967 Oct;3(2):192–202. doi: 10.1016/0034-5687(67)90009-6. [DOI] [PubMed] [Google Scholar]
  29. Stadie W. C., Martin K. A. THE ELIMINATION OF CARBON MONOXIDE FROM THE BLOOD: A Theoretical and Experimental Study. J Clin Invest. 1925 Oct;2(1):77–91. doi: 10.1172/JCI100035. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Staub N. C., Nagano H., Pearce M. L. Pulmonary edema in dogs, especially the sequence of fluid accumulation in lungs. J Appl Physiol. 1967 Feb;22(2):227–240. doi: 10.1152/jappl.1967.22.2.227. [DOI] [PubMed] [Google Scholar]
  31. Stephenson S. F., Esrig B. C., Polk H. C., Jr, Fulton R. L. The pathophysiology of smoke inhalation injury. Ann Surg. 1975 Nov;182(5):652–660. doi: 10.1097/00000658-197511000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Thornton D., Ponhold H., Butler J., Morgan T., Cheney F. W. Effects of pattern of ventilation on pulmonary metabolism and mechanics. Anesthesiology. 1975 Jan;42(1):4–10. [PubMed] [Google Scholar]
  33. WIDDICOMBE J. G. Regulation of tracheobronchial smooth muscle. Physiol Rev. 1963 Jan;43:1–37. doi: 10.1152/physrev.1963.43.1.1. [DOI] [PubMed] [Google Scholar]
  34. Wagner W. W., Jr Pulmonary microcirculatory observations in vivo under physiological conditions. J Appl Physiol. 1969 Mar;26(3):375–377. doi: 10.1152/jappl.1969.26.3.375. [DOI] [PubMed] [Google Scholar]
  35. Webb W. R., Cook W. A., Lanius J. W., Shaw R. R. Cigarette smoke and surfactant. Am Rev Respir Dis. 1967 Feb;95(2):244–247. doi: 10.1164/arrd.1967.95.2.244. [DOI] [PubMed] [Google Scholar]
  36. Wyszogrodski I., Kyei-Aboagye K., Taeusch H. W., Jr, Avery M. E. Surfactant inactivation by hyperventilation: conservation by end-expiratory pressure. J Appl Physiol. 1975 Mar;38(3):461–466. doi: 10.1152/jappl.1975.38.3.461. [DOI] [PubMed] [Google Scholar]
  37. Zawacki B. E., Jung R. C., Joyce J., Rincon E. Smoke, burns, and the natural history of inhalation injury in fire victims: a correlation of experimental and clinical data. Ann Surg. 1977 Jan;185(1):100–110. doi: 10.1097/00000658-197701000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. 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]
  39. Zikria B. A., Sturner W. Q., Astarjian N. K., Fox C. L., Jr, Ferrer J. M., Jr Respiratory tract damage in burns: pathophysiology and therapy. Ann N Y Acad Sci. 1968 Aug 14;150(3):618–626. doi: 10.1111/j.1749-6632.1968.tb14714.x. [DOI] [PubMed] [Google Scholar]
  40. Zikria B. A., Weston G. C., Chodoff M., Ferrer J. M. Smoke and carbon monoxide poisoning in fire victims. J Trauma. 1972 Aug;12(8):641–645. doi: 10.1097/00005373-197208000-00001. [DOI] [PubMed] [Google Scholar]

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