Morphometry of parenchymal and vascular alterations in ARDS after extracorporal carbon dioxide removal therapy (ECCO2-R-therapy).
The lungs of 12 patients suffering from ARDS treated by ECCO2-R-therapy were examined. The thickness of the interlobular septa, area portions of honeycombing, bleeding and lung parenchyma with diffuse alveolar damage were assessed by semi-automatic image analysis. Medial thickness of the pulmonary arteries with an external radius ranging between 40 microns and 150 microns was assessed planimetrically. The area portion of honeycombing ranged from 0% to 66% (average: 28.8%, standard deviation: 17.0%). The thickness of interlobular septa was increased with values between 74.0 microns and 195.5 microns (average: 140.4 microns, standard deviation: 41.7 microns; normal controls: 72.0 microns +/- 19.5 microns). Parenchymal and vascular changes were closely related: Average medial thickness rose from nearly normal values (4.9%) in cases with low area portions of honeycombing and bleeding to the double (11.1%) of normal values in cases with area portions of honeycombing and bleeding greater than 40%. We conclude that parenchymal changes due to shock and high inspiratory O2 concentration lead to changes of the pulmonary arterial hemodynamics which result in a quickly developing medial hypertrophy.
Barth
P J
PJ
Dept. of Pathology, Philipps-Universität Marburg, FRG.
Knoch
M
M
Müller
E
E
Sangmeister
C
C
Bittinger
A
A
D000293:Adolescent; D000328:Adult; D001344:Autopsy; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000098:blood supply / Q000473:pathology / Q000502:physiology; D011651:Pulmonary Artery / Q000473:pathology; D012127:Respiratory Distress Syndrome, Newborn / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy*; D014655:Vascular Resistance / Q000502:physiology
D002245:Carbon Dioxide