title: Distribution and function of alveolar cells in multiply injured patients with trauma-induced ARDS.
abstract: To determine whether alveolar cells are involved in the pathogenesis of adult respiratory distress syndrome (ARDS), we assessed the distribution and function of alveolar cells from 30 polytraumatized patients with trauma-induced respiratory failure, 5 of whom also had lung contusion. Cells were obtained by bronchoalveolar lavage performed daily beginning on the day of trauma and continuing for 14 days. Neutrophils constituted about 60% of lavage cells in ARDS patients with lung contusion 0-2 days after polytrauma and about 50% in ARDS patients without lung contusion. In ARDS patients with lung contusion the neutrophil fraction decreased to 52% 3-6 days after trauma and to 40% 7-14 days after trauma. In patients without lung contusion the neutrophil fraction increased to 77% and then decreased to 60% at these times. Total cell counts in ARDS patients with lung contusion were more than twice as high as in patients without lung contusion 0-2 days after trauma. The difference in total cell counts decreased during days 3-6 and disappeared by day 7. In all patients morphologically altered alveolar cells were observed 4 days and more after trauma. In non-survivors significantly more altered cells were found. The chemiluminescence-response pattern of the alveolar cells was enhanced throughout the study and correlated with the neutrophil fraction (r = 0.6). The neutrophil fraction also correlated with the pulmonary vascular resistance during the first two days after trauma (r = 0.53). We conclude that alveolar cells are involved in the pathogenesis of trauma-induced ARDS and that the alveolar cell distribution is different in patients with and without lung contusion during the development of posttraumatic respiratory failure.
authors.affiliation: Department of Trauma Surgery Medical Faculty, University of Essen, FRG.
authors.forename: U
authors.initials: U
authors.lastname: Pison
authors.forename: M
authors.initials: M
authors.lastname: Brand
authors.forename: T
authors.initials: T
authors.lastname: Joka
authors.forename: U
authors.initials: U
authors.lastname: Obertacke
authors.forename: J
authors.initials: J
authors.lastname: Bruch
mesh_terms: D000208:Acute Disease; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology* / Q000473:pathology; D003131:Combined Modality Therapy; D003288:Contusions / Q000209:etiology / Q000473:pathology; D006801:Humans; D008214:Lymphocytes; D008264:Macrophages; D009104:Multiple Trauma / Q000150:complications*; D009504:Neutrophils; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000473:pathology; D012720:Severity of Illness Index; D013898:Thoracic Injuries / Q000209:etiology* / Q000473:pathology; D013997:Time Factors