Determinants of Pulmonary Interstitial Fluid Accumulation after Trauma

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Abstract
The daily extravascular lung water (EVLW) changes were sequentially measured in 16 severly traumatized patients, to better define the principal etiologic factors causing posttraumatic interstitial fluid accumulation and subsequent respiratory failure. Severe hemorrhagic shock (mean initial BP [blood pressure] = 40 mm Hg), massive transfusion (12.7 l of blood) and crystalloid resuscitation with resulting hemodilution of plasma colloid osmotic pressure (PCOP) (PCOP .ltoreq. 15 mm Hg) do not cause EVLW accumulation. Posttraumatic elevations in EVLW were seen after lung contusion (average EVLW = 15.3 .+-. 2.5 ml/kg), sepsis (average EVLW = 17.1 .+-. 2.9 ml/kg) and cardiac failure (EVLW = 15.3 .+-. 0.3 ml/kg). After trauma, elevations in capillary hydrostatic pressure and capillary permeability alterations resulting from lung contusion or sepsis are the primary determinants of interstitial fluid accumulation.

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