Controversies in the fluid management of post-traumatic lung disease

David H Wisner, J. A. Sturm

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

The appropriate intravenous therapy for injured patients is controversial. Use of colloid-containing solutions has been advocated in an attempt to maintain intravascular colloid osmotic pressure, minimize pulmonary oedema and draw fluid out of areas of contused lung. Studies of animals with lymph fistulas in the lung do not support such therapy and there is no difference between lung water volumes in animals resuscitated for 3 hours with colloid as opposed to crystalloid solutions after a standardized traumatic insult (colloid = 8.4 + 0.8 ml/kg; crystalloid = 7.5 + 0.6 ml/kg). Increased pulmonary capillary permeability makes such therapeutic attempts to 'dry out' the lungs even less effective. Studies in human patients of the rate of extravasation of labelled albumin from the pulmonary intravascular space indicate that increased permeability of pulmonary capillaries occurs early after injury and remains elevated in many severely injured patients. Low plasma colloid osmotic pressures do not correlate with increases in extravascular lung water. A shift to the use of vigorous crystalloid resuscitation of injured patients at our institution has resulted in decreases in both mortality rate (1976-1979, 35 per cent; 1979-1981, 28 per cent) and the rate of dialysis-dependent renal failure (1976-1979, 6 per cent; 1979-1981, 2 per cent). Current evidence supports the use of crystalloid solutions together with blood for resuscitation after injury.

Original languageEnglish (US)
Pages (from-to)295-300
Number of pages6
JournalInjury
Volume17
Issue number5
DOIs
StatePublished - 1986
Externally publishedYes

Fingerprint

Lung Diseases
Colloids
Lung
Osmotic Pressure
Capillary Permeability
Resuscitation
Extravascular Lung Water
Contusions
Wounds and Injuries
Lymph
Pulmonary Edema
Fistula
Renal Insufficiency
Dialysis
Albumins
Therapeutics
Mortality
crystalloid solutions
Water

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Controversies in the fluid management of post-traumatic lung disease. / Wisner, David H; Sturm, J. A.

In: Injury, Vol. 17, No. 5, 1986, p. 295-300.

Research output: Contribution to journalArticle

Wisner, David H ; Sturm, J. A. / Controversies in the fluid management of post-traumatic lung disease. In: Injury. 1986 ; Vol. 17, No. 5. pp. 295-300.
@article{4e434a77b1c74403aec9de0362a69c57,
title = "Controversies in the fluid management of post-traumatic lung disease",
abstract = "The appropriate intravenous therapy for injured patients is controversial. Use of colloid-containing solutions has been advocated in an attempt to maintain intravascular colloid osmotic pressure, minimize pulmonary oedema and draw fluid out of areas of contused lung. Studies of animals with lymph fistulas in the lung do not support such therapy and there is no difference between lung water volumes in animals resuscitated for 3 hours with colloid as opposed to crystalloid solutions after a standardized traumatic insult (colloid = 8.4 + 0.8 ml/kg; crystalloid = 7.5 + 0.6 ml/kg). Increased pulmonary capillary permeability makes such therapeutic attempts to 'dry out' the lungs even less effective. Studies in human patients of the rate of extravasation of labelled albumin from the pulmonary intravascular space indicate that increased permeability of pulmonary capillaries occurs early after injury and remains elevated in many severely injured patients. Low plasma colloid osmotic pressures do not correlate with increases in extravascular lung water. A shift to the use of vigorous crystalloid resuscitation of injured patients at our institution has resulted in decreases in both mortality rate (1976-1979, 35 per cent; 1979-1981, 28 per cent) and the rate of dialysis-dependent renal failure (1976-1979, 6 per cent; 1979-1981, 2 per cent). Current evidence supports the use of crystalloid solutions together with blood for resuscitation after injury.",
author = "Wisner, {David H} and Sturm, {J. A.}",
year = "1986",
doi = "10.1016/0020-1383(86)90149-X",
language = "English (US)",
volume = "17",
pages = "295--300",
journal = "Injury",
issn = "0020-1383",
publisher = "Elsevier Limited",
number = "5",

}

TY - JOUR

T1 - Controversies in the fluid management of post-traumatic lung disease

AU - Wisner, David H

AU - Sturm, J. A.

PY - 1986

Y1 - 1986

N2 - The appropriate intravenous therapy for injured patients is controversial. Use of colloid-containing solutions has been advocated in an attempt to maintain intravascular colloid osmotic pressure, minimize pulmonary oedema and draw fluid out of areas of contused lung. Studies of animals with lymph fistulas in the lung do not support such therapy and there is no difference between lung water volumes in animals resuscitated for 3 hours with colloid as opposed to crystalloid solutions after a standardized traumatic insult (colloid = 8.4 + 0.8 ml/kg; crystalloid = 7.5 + 0.6 ml/kg). Increased pulmonary capillary permeability makes such therapeutic attempts to 'dry out' the lungs even less effective. Studies in human patients of the rate of extravasation of labelled albumin from the pulmonary intravascular space indicate that increased permeability of pulmonary capillaries occurs early after injury and remains elevated in many severely injured patients. Low plasma colloid osmotic pressures do not correlate with increases in extravascular lung water. A shift to the use of vigorous crystalloid resuscitation of injured patients at our institution has resulted in decreases in both mortality rate (1976-1979, 35 per cent; 1979-1981, 28 per cent) and the rate of dialysis-dependent renal failure (1976-1979, 6 per cent; 1979-1981, 2 per cent). Current evidence supports the use of crystalloid solutions together with blood for resuscitation after injury.

AB - The appropriate intravenous therapy for injured patients is controversial. Use of colloid-containing solutions has been advocated in an attempt to maintain intravascular colloid osmotic pressure, minimize pulmonary oedema and draw fluid out of areas of contused lung. Studies of animals with lymph fistulas in the lung do not support such therapy and there is no difference between lung water volumes in animals resuscitated for 3 hours with colloid as opposed to crystalloid solutions after a standardized traumatic insult (colloid = 8.4 + 0.8 ml/kg; crystalloid = 7.5 + 0.6 ml/kg). Increased pulmonary capillary permeability makes such therapeutic attempts to 'dry out' the lungs even less effective. Studies in human patients of the rate of extravasation of labelled albumin from the pulmonary intravascular space indicate that increased permeability of pulmonary capillaries occurs early after injury and remains elevated in many severely injured patients. Low plasma colloid osmotic pressures do not correlate with increases in extravascular lung water. A shift to the use of vigorous crystalloid resuscitation of injured patients at our institution has resulted in decreases in both mortality rate (1976-1979, 35 per cent; 1979-1981, 28 per cent) and the rate of dialysis-dependent renal failure (1976-1979, 6 per cent; 1979-1981, 2 per cent). Current evidence supports the use of crystalloid solutions together with blood for resuscitation after injury.

UR - http://www.scopus.com/inward/record.url?scp=0022553379&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022553379&partnerID=8YFLogxK

U2 - 10.1016/0020-1383(86)90149-X

DO - 10.1016/0020-1383(86)90149-X

M3 - Article

VL - 17

SP - 295

EP - 300

JO - Injury

JF - Injury

SN - 0020-1383

IS - 5

ER -