Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1988 Jul;208(1):56–64. doi: 10.1097/00000658-198807000-00008

Effects of crystalloid on lung fluid balance after smoke inhalation.

W R Clark Jr 1, G F Nieman 1, D Goyette 1, D Gryzboski 1
PMCID: PMC1493561  PMID: 3389945

Abstract

Inhalation injury occurs in 21% of flame burn victims who require large fluid volumes for resuscitation and have a mortality rate greater than 30%. This study was done to determine how vulnerable the smoke-injured lung is to fluid accumulation when crystalloids are infused rapidly. Mongrel dogs were exposed to smoke and 10% body-weight Ringer's lactate in three groups: (I) fluid only, (II) smoke only, and (III) smoke and fluid. The increase in wet-dry lung weight ratio was 2% in Group I, 28% in Group II, and 42% in Group III, consistent with pulmonary edema present only in Group III. The decrease in colloid oncotic pressure was similar in both of the groups that were given fluid, and the rise in the surface tension minimum of lung extracts was similar in both of the groups that were exposed to smoke. The smoke-injured lung loses the ability to protect itself when challenged with fluid. Reduced oncotic pressure is not responsible. Changes in microvascular pressure, endothelial and epithelial damage, and surfactant inactivation interact to cause this increase in extravascular lung water.

Full text

PDF
56

Selected References

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

  1. Ali J., Chernicki W., Wood L. D. Effect of furosemide in canine low-pressure pulmonary edema. J Clin Invest. 1979 Nov;64(5):1494–1504. doi: 10.1172/JCI109608. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Arfors K. E., Rutili G., Svensjö E. Microvascular transport of macromolecules in normal and inflammatory conditions. Acta Physiol Scand Suppl. 1979;463:93–103. [PubMed] [Google Scholar]
  3. Birky M., Malek D., Paabo M. Study of biological samples obtained from victims of MGM Grand Hotel fire. J Anal Toxicol. 1983 Nov-Dec;7(6):265–271. doi: 10.1093/jat/7.6.265. [DOI] [PubMed] [Google Scholar]
  4. Bredenberg C. E., Nieman G. F., Paskanik A. M., Hart A. K. Microvascular membrane permeability in high surface tension pulmonary edema. J Appl Physiol (1985) 1986 Jan;60(1):253–259. doi: 10.1152/jappl.1986.60.1.253. [DOI] [PubMed] [Google Scholar]
  5. CLEMENTS J. A., HUSTEAD R. F., JOHNSON R. P., GRIBETZ I. Pulmonary surface tension and alveolar stability. J Appl Physiol. 1961 May;16:444–450. doi: 10.1152/jappl.1961.16.3.444. [DOI] [PubMed] [Google Scholar]
  6. CLEMENTS J. A. Surface tension of lung extracts. Proc Soc Exp Biol Med. 1957 May;95(1):170–172. doi: 10.3181/00379727-95-23156. [DOI] [PubMed] [Google Scholar]
  7. Clark W. R., Fromm B. S. Burn mortality. Experience at a regional burn unit. Literature review. Acta Chir Scand Suppl. 1987;537:1–126. [PubMed] [Google Scholar]
  8. Collins J. A., Braitberg A., Butcher H. R., Jr Changes in lung and body weight and lung water content in rats treated for hemorrhage with various fluids. Surgery. 1973 Mar;73(3):401–411. [PubMed] [Google Scholar]
  9. Collins J. C., Newman J. H., Wickersham N. E., Vaughn W. K., Snapper J. R., Harris T. R., Brigham K. L. Relation of blood-free to blood-inclusive postmortem lung water measurements in sheep. J Appl Physiol (1985) 1985 Aug;59(2):592–596. doi: 10.1152/jappl.1985.59.2.592. [DOI] [PubMed] [Google Scholar]
  10. Davies J. W. Toxic chemicals versus lung tissue--an aspect of inhalation injury revisited. The Everett Idris Evans memorial lecture--1986. J Burn Care Rehabil. 1986 May-Jun;7(3):213–222. doi: 10.1097/00004630-198605000-00004. [DOI] [PubMed] [Google Scholar]
  11. Demling R. H. Fluid resuscitation after major burns. JAMA. 1983 Sep 16;250(11):1438–1440. [PubMed] [Google Scholar]
  12. Demling R. H., Kramer G., Harms B. Role of thermal injury-induced hypoproteinemia on fluid flux and protein permeability in burned and nonburned tissue. Surgery. 1984 Feb;95(2):136–144. [PubMed] [Google Scholar]
  13. Demling R. H., Manohar M., Will J. A. Relation between pulmonary transvascular fluid filtration rate and measured Starling's forces after major burn. Chest. 1979 Oct;76(4):448–452. doi: 10.1378/chest.76.4.448. [DOI] [PubMed] [Google Scholar]
  14. Demling R. H., Niehaus G., Perea A., Will J. A. Effect of burn-induced hypoproteinemia on pulmonary transvascular fluid filtration rate. Surgery. 1979 Mar;85(3):339–343. [PubMed] [Google Scholar]
  15. Demling R. H., Will J. A., Belzer F. O. Effect of major thermal injury on the pulmonary microcirculation. Surgery. 1978 Jun;83(6):746–751. [PubMed] [Google Scholar]
  16. Demling R. H., Will J. A., Belzer F. O. Effect of major thermal injury on the pulmonary microcirculation. Surgery. 1978 Jun;83(6):746–751. [PubMed] [Google Scholar]
  17. Egan E. A. Fluid balance in the air filled alveolar space. Am Rev Respir Dis. 1983 May;127(5 Pt 2):S37–S39. [PubMed] [Google Scholar]
  18. Erdmann A. J., 3rd, Vaughan T. R., Jr, Brigham K. L., Woolverton W. C., Staub N. C. Effect of increased vascular pressure on lung fluid balance in unanesthetized sheep. Circ Res. 1975 Sep;37(3):271–284. doi: 10.1161/01.res.37.3.271. [DOI] [PubMed] [Google Scholar]
  19. FELLER I., HENDRIX R. C. CLINICAL PATHOLOGIC STUDY OF SIXTY FATALLY BURNED PATIENTS. Surg Gynecol Obstet. 1964 Jul;119:1–5. [PubMed] [Google Scholar]
  20. 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]
  21. GUYTON A. C., LINDSEY A. W. Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema. Circ Res. 1959 Jul;7(4):649–657. doi: 10.1161/01.res.7.4.649. [DOI] [PubMed] [Google Scholar]
  22. Gaar K. A., Jr, Taylor A. E., Owens L. J., Guyton A. C. Effect of capillary pressure and plasma protein on development of pulmonary edema. Am J Physiol. 1967 Jul;213(1):79–82. doi: 10.1152/ajplegacy.1967.213.1.79. [DOI] [PubMed] [Google Scholar]
  23. Gaar K. A., Jr, Taylor A. E., Owens L. J., Guyton A. C. Pulmonary capillary pressure and filtration coefficient in the isolated perfused lung. Am J Physiol. 1967 Oct;213(4):910–914. doi: 10.1152/ajplegacy.1967.213.4.910. [DOI] [PubMed] [Google Scholar]
  24. 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]
  25. 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]
  26. Guyton A. C., Taylor A. E., Drake R. E., Parker J. C. Dynamics of subatmospheric pressure in the pulmonary interstitial fluid. Ciba Found Symp. 1976;(38):77–100. doi: 10.1002/9780470720202.ch6. [DOI] [PubMed] [Google Scholar]
  27. Harms B. A., Bodai B. I., Kramer G. C., Demling R. H. Microvascular fluid and protein flux in pulmonary and systemic circulations after thermal injury. Microvasc Res. 1982 Jan;23(1):77–86. doi: 10.1016/0026-2862(82)90032-2. [DOI] [PubMed] [Google Scholar]
  28. Herndon D. N., Abston S., Stein M. D. Increased thromboxane B2 levels in the plasma of burned and septic burned patients. Surg Gynecol Obstet. 1984 Sep;159(3):210–213. [PubMed] [Google Scholar]
  29. Herndon D. N., Adams T., Jr, Traber L. D., Traber D. L. Inhalation injury and positive pressure ventilation in a sheep model. Circ Shock. 1984;12(2):107–113. [PubMed] [Google Scholar]
  30. Herndon D. N., Barrow R. E., Traber D. L., Rutan T. C., Rutan R. L., Abston S. Extravascular lung water changes following smoke inhalation and massive burn injury. Surgery. 1987 Aug;102(2):341–349. [PubMed] [Google Scholar]
  31. Herndon D. N., Traber D. L., Niehaus G. D., Linares H. A., Traber L. D. The pathophysiology of smoke inhalation injury in a sheep model. J Trauma. 1984 Dec;24(12):1044–1051. doi: 10.1097/00005373-198412000-00007. [DOI] [PubMed] [Google Scholar]
  32. Herndon D. N., Traber D. L., Traber L. D. The effect of resuscitation on inhalation injury. Surgery. 1986 Aug;100(2):248–251. [PubMed] [Google Scholar]
  33. Kennedy S. M., Elwood R. K., Wiggs B. J., Paré P. D., Hogg J. C. Increased airway mucosal permeability of smokers. Relationship to airway reactivity. Am Rev Respir Dis. 1984 Jan;129(1):143–148. doi: 10.1164/arrd.1984.129.1.143. [DOI] [PubMed] [Google Scholar]
  34. Kramer G. C., Harms B. A., Gunther R. A., Renkin E. M., Demling R. H. The effects of hypoproteinemia on blood-to-lymph fluid transport in sheep lung. Circ Res. 1981 Nov;49(5):1173–1180. doi: 10.1161/01.res.49.5.1173. [DOI] [PubMed] [Google Scholar]
  35. Lum H., Mitzner W. A species comparison of alveolar size and surface forces. J Appl Physiol (1985) 1987 May;62(5):1865–1871. doi: 10.1152/jappl.1987.62.5.1865. [DOI] [PubMed] [Google Scholar]
  36. Mayers I., Stimpson R., Oppenheimer L. Delayed resolution of high-pressure pulmonary edema or capillary leak. Surgery. 1987 Apr;101(4):450–458. [PubMed] [Google Scholar]
  37. Mitzner W., Sylvester J. T. Lymph flow and lung weight in isolated sheep lungs. J Appl Physiol (1985) 1986 Nov;61(5):1830–1835. doi: 10.1152/jappl.1986.61.5.1830. [DOI] [PubMed] [Google Scholar]
  38. Moss G. S., das Gupta T. K., Newson B., Nyhus L. M. The effect of saline solution resuscitation on pulmonary sodium and water distribution. Surg Gynecol Obstet. 1973 Jun;136(6):934–940. [PubMed] [Google Scholar]
  39. Navar P. D., Saffle J. R., Warden G. D. Effect of inhalation injury on fluid resuscitation requirements after thermal injury. Am J Surg. 1985 Dec;150(6):716–720. doi: 10.1016/0002-9610(85)90415-5. [DOI] [PubMed] [Google Scholar]
  40. Nieman G. F., Bredenberg C. E. High surface tension pulmonary edema induced by detergent aerosol. J Appl Physiol (1985) 1985 Jan;58(1):129–136. doi: 10.1152/jappl.1985.58.1.129. [DOI] [PubMed] [Google Scholar]
  41. Nieman G. F., Clark W. R., Jr, Wax S. D., Webb S. R. The effect of smoke inhalation on pulmonary surfactant. Ann Surg. 1980 Feb;191(2):171–181. doi: 10.1097/00000658-198002000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Ohkuda K., Nakahara K., Weidner W. J., Binder A., Staub N. C. Lung fluid exchange after uneven pulmonary artery obstruction in sheep. Circ Res. 1978 Aug;43(2):152–161. doi: 10.1161/01.res.43.2.152. [DOI] [PubMed] [Google Scholar]
  43. Overholser K. A., Bhattacharya J., Staub N. C. Microvascular pressures in the isolated, perfused dog lung: comparison between theory and measurement. Microvasc Res. 1982 Jan;23(1):67–76. doi: 10.1016/0026-2862(82)90031-0. [DOI] [PubMed] [Google Scholar]
  44. Parker J. C., Falgout H. J., Parker R. E., Granger D. N., Taylor A. E. The effect of fluid volume loading on exclusion of interstitial albumin and lymph flow in the dog lung. Circ Res. 1979 Oct;45(4):440–450. doi: 10.1161/01.res.45.4.440. [DOI] [PubMed] [Google Scholar]
  45. Parker J. C., Parker R. E., Granger D. N., Taylor A. E. Vascular permeability and transvascular fluid and protein transport in the dog lung. Circ Res. 1981 Apr;48(4):549–561. doi: 10.1161/01.res.48.4.549. [DOI] [PubMed] [Google Scholar]
  46. Peitzman A. B., Shires G. T., 3rd, Corbett W. A., Curreri P. W., Shires G. T. Measurement of lung water in inhalation injury. Surgery. 1981 Aug;90(2):305–312. [PubMed] [Google Scholar]
  47. Prien T., Traber L. D., Herndon D. N., Stothert J. C., Jr, Lubbesmeyer H. J., Traber D. L. Pulmonary edema with smoke inhalation, undetected by indicator-dilution technique. J Appl Physiol (1985) 1987 Sep;63(3):907–911. doi: 10.1152/jappl.1987.63.3.907. [DOI] [PubMed] [Google Scholar]
  48. Rutili G., Parker J. C., Taylor A. E. Fluid balance in ANTU-injured lungs during crystalloid and colloid infusions. J Appl Physiol Respir Environ Exerc Physiol. 1984 Apr;56(4):993–998. doi: 10.1152/jappl.1984.56.4.993. [DOI] [PubMed] [Google Scholar]
  49. SAID S. I., AVERY M. E., DAVIS R. K., BANERJEE C. M., EL-GOHARY M. PULMONARY SURFACE ACTIVITY IN INDUCED PULMONARY EDEMA. J Clin Invest. 1965 Mar;44:458–464. doi: 10.1172/JCI105159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Scheulen J. J., Munster A. M. The Parkland formula in patients with burns and inhalation injury. J Trauma. 1982 Oct;22(10):869–871. doi: 10.1097/00005373-198210000-00011. [DOI] [PubMed] [Google Scholar]
  51. Shimazu T., Yukioka T., Hubbard G. B., Langlinais P. C., Mason A. D., Jr, Pruitt B. A., Jr A dose-responsive model of smoke inhalation injury. Severity-related alteration in cardiopulmonary function. Ann Surg. 1987 Jul;206(1):89–98. doi: 10.1097/00000658-198707000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Shirani K. Z., Pruitt B. A., Jr, Mason A. D., Jr The influence of inhalation injury and pneumonia on burn mortality. Ann Surg. 1987 Jan;205(1):82–87. doi: 10.1097/00000658-198701000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Snashall P. D., Weidner W. J., Staub N. C. Extravascular lung water after extracellular fluid volume expansion in dogs. J Appl Physiol Respir Environ Exerc Physiol. 1977 Apr;42(4):624–629. doi: 10.1152/jappl.1977.42.4.624. [DOI] [PubMed] [Google Scholar]
  54. 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]
  55. Thomas P. A. A technique for surface tension determination of extracts from lung biopsy specimens. J Surg Res. 1966 Mar;6(3):142–144. doi: 10.1016/s0022-4804(66)80069-0. [DOI] [PubMed] [Google Scholar]
  56. Thompson P. B., Herndon D. N., Traber D. L., Abston S. Effect on mortality of inhalation injury. J Trauma. 1986 Feb;26(2):163–165. doi: 10.1097/00005373-198602000-00012. [DOI] [PubMed] [Google Scholar]
  57. Traber D. L., Schlag G., Redl H., Traber L. D. Pulmonary edema and compliance changes following smoke inhalation. J Burn Care Rehabil. 1985 Nov-Dec;6(6):490–494. doi: 10.1097/00004630-198511000-00007. [DOI] [PubMed] [Google Scholar]
  58. Tranbaugh R. F., Elings V. B., Christensen J. M., Lewis F. R. Effect of inhalation injury on lung water accumulation. J Trauma. 1983 Jul;23(7):597–604. doi: 10.1097/00005373-198307000-00009. [DOI] [PubMed] [Google Scholar]
  59. Tranbaugh R. F., Lewis F. R., Christensen J. M., Elings V. B. Lung water changes after thermal injury. The effects of crystalloid resuscitation and sepsis. Ann Surg. 1980;192(4):479–490. doi: 10.1097/00000658-198010000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Zarins C. K., Rice C. L., Peters R. M., Virgilio R. W. Lymph and pulmonary response to isobaric reduction in plasma oncotic pressure in baboons. Circ Res. 1978 Dec;43(6):925–930. doi: 10.1161/01.res.43.6.925. [DOI] [PubMed] [Google Scholar]
  61. 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]

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

RESOURCES