title: Alterations of pulmonary gas exchange after superimposed carbon monoxide poisoning in acute lung injury.
abstract: BACKGROUND
  Smoke inhalation injury produces substantial morbidity and mortality caused both by immediate catastrophic pulmonary failure and by the subsequent development of pneumonia. Although carbon monoxide (CO) poisoning is present to a degree in nearly all instances of smoke inhalation, the importance of CO in the pathogenesis of smoke inhalation injury remains controversial because smoke contains numerous other potential pulmonary toxins such as aldehydes, chlorine gas, and hydrochloric acid. This study was performed to determine whether CO poisoning acts as a cofactor in the evolution of inhalation injury.
  
  
  METHODS
  Four groups of anesthetized dogs received ventilation with 1% CO in room air alone, intratracheal instillation of 2.0 ml/kg 0.1 N hydrochloric acid (HCl) alone, or acid either immediately or 30 minutes before CO. Ventilation/perfusion relationships were measured for 4 hours thereafter with the multiple inert gas elimination technique.
  
  
  RESULTS
  Acid instillation established 30 minutes before CO poisoning resulted in significantly decreased carboxyhemoglobin concentrations after ventilation with 1% CO in air for 10 minutes. However, CO elimination was markedly delayed in both acid-challenged groups ventilated with CO. Moreover, acid instillation immediately before CO poisoning significantly exacerbated the development of ventilation/perfusion inequality caused by the acid, because the development of shunt was accelerated.
  
  
  CONCLUSIONS
  CO poisoning is an important cofactor in the development of inhalation injury by acceleration of the development of ventilation/perfusion inequality after inhalation.
authors.affiliation: Department of Surgery, Cornell University Medical College, New York, N.Y.
authors.forename: P S
authors.initials: PS
authors.lastname: Barie
authors.forename: W
authors.initials: W
authors.lastname: Wu
authors.forename: R J
authors.initials: RJ
authors.lastname: Hariri
authors.forename: P H
authors.initials: PH
authors.lastname: Halebian
authors.forename: G T
authors.initials: GT
authors.lastname: Shires
mesh_terms: D000818:Animals; D002249:Carbon Monoxide Poisoning / Q000150:complications* / Q000503:physiopathology; D002263:Carboxyhemoglobin / Q000493:pharmacokinetics; D004285:Dogs; D006207:Half-Life; D006439:Hemodynamics; D008168:Lung / Q000098:blood supply; D010100:Oxygen / Q000097:blood; D011659:Pulmonary Gas Exchange; D011897:Random Allocation; D012039:Regional Blood Flow; D012044:Regression Analysis; D015208:Smoke Inhalation Injury / Q000209:etiology* / Q000503:physiopathology
chemical_list: D002263:Carboxyhemoglobin; D010100:Oxygen