Pulmonary coagulopathy as a new target in therapeutic studies of acute lung injury or pneumonia--a review.
OBJECTIVE
To review the involvement of coagulation and fibrinolysis in the pathogenesis of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), pulmonary infection, and ventilator-induced lung injury (VILI).


METHODS
Published articles on experimental and clinical studies of coagulation and fibrinolysis in ALI/ARDS, pneumonia, and mechanical ventilation.


CONCLUSIONS
Alveolar fibrin deposition is an important feature of ALI/ARDS and pulmonary infection. The mechanisms that contribute to disturbed alveolar fibrin turnover are localized tissue factor-mediated thrombin generation and depression of bronchoalveolar urokinase plasminogen activator-mediated fibrinolysis, caused by the increase of plasminogen activator inhibitors. These effects on pulmonary coagulation and fibrinolysis are regulated by various proinflammatory cytokines and are similar to those found in the intravascular spaces during severe systemic inflammation. Some studies also suggest that pulmonary coagulopathy is a feature of VILI. Recent studies have demonstrated the beneficial effect of anticoagulant therapy in sepsis. Theoretical considerations suggest that this anticoagulant therapy will benefit patients with primary lung pathology including VILI, but clinical studies are needed to examine this hypothesis before such therapy is to be advocated as a standard of care in critically ill patients.
Schultz
Marcus J
MJ
Department of Intensive Care Medicine, University of Amsterdam, Netherlands, and the Interdepartmental Division of Critical Care, St. Michael's Hospital, Toronto, ON, Canada.
Haitsma
Jack J
JJ
Zhang
Haibo
H
Slutsky
Arthur S
AS
D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D005342:Fibrinolysis; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D011014:Pneumonia / Q000150:complications* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy