title: Pulmonary activation of coagulation and inhibition of fibrinolysis after burn injuries and inhalation trauma.
abstract: BACKGROUND
  Pulmonary coagulopathy is intrinsic to pneumonia and other forms of acute lung injury. We hypothesized patients with burn injuries and inhalation trauma to have similar alterations in pulmonary coagulation and fibrinolysis.
  
  
  METHODS
  We performed a prospective study on changes in pulmonary and systemic thrombin generation and fibrinolytic activity in patients with burn injuries and inhalation trauma requiring mechanical ventilation. Nondirected bronchial lavage was performed on alternate days. Patients requiring mechanical ventilation for nonpulmonary reasons who did not meet the North American European Consensus Conference criteria for acute lung injury functioned as control patients.
  
  
  RESULTS
  We studied 13 patients with burn injuries and inhalation trauma and 15 control patients. On admission, patients with burn injuries and inhalation trauma showed a significant increase in thrombin generation in the airways compared with control patients, as reflected by increased lavage fluid levels of thrombin-antithrombin complexes and fibrin degradation products, and decreased lavage fluid levels of activated protein C and antithrombin. Simultaneously, burn patients showed a significant decrease in fibrinolytic activity, as reflected by decreased lavage fluid levels of plasminogen activator activity. Pulmonary coagulopathy persisted throughout the period of mechanical ventilation and was accompanied by similar changes in systemic coagulation and fibrinolysis. There was no significant correlation between changes in coagulation and fibrinolysis and the extent of burn injury.
  
  
  CONCLUSIONS
  Patients with burn injuries and inhalation trauma requiring mechanical ventilation show a distinct and sustained procoagulant and antifibrinolytic shift in the pulmonary compartment. Pulmonary coagulopathy could be an important therapeutic target in these patients.
authors: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Jorrit J
authors: JJ
authors: Hofstra
authors: Alexander P
authors: AP
authors: Vlaar
authors: Paul
authors: P
authors: Knape
authors: Dave P
authors: DP
authors: Mackie
authors: Rogier M
authors: RM
authors: Determann
authors: Goda
authors: G
authors: Choi
authors: Tom
authors: T
authors: van der Poll
authors: Marcel
authors: M
authors: Levi
authors: Marcus J
authors: MJ
authors: Schultz
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001779:Blood Coagulation Factors / Q000032:analysis; D018893:Bronchoalveolar Lavage; D002059:Burns, Inhalation / Q000150:complications*; D016022:Case-Control Studies; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011014:Pneumonia / Q000209:etiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D001779:Blood Coagulation Factors