Die posttraumatische respiratorische Insuffizienz

Summary

The pathophysiology of pulmonary and extrapulmonary respiratory changes which follow trauma are reviewed and simple diagnostic measures given for their early bedside recognition. Posttraumatic respiratory insufficiency which has become the major cause of death of patients in shock develops primarely on the basis of ventilation-perfusion inequalities: e.g. shunt, deadspace and silent unit. Daily measurements of the alveoloarterial oxygen gradient (AaDO₂) in severely ill patients helps to recognizeshunt flow by simple means in an early state when therapeutic measures are still successful. Thedeadspace to tidal volume relation (V_D/V_T) increases after injury as result of plateletaggregation and hemorrhage.Transcapillary fluid loss is often a consequence of beginning left heart failure, hypoproteinemia (hemodilution due to excessive administration of colloid free solutions), aspiration and high positive airwaypressures or oxygen concentrations during artificial respiration. Deficiences in oxygen transport have lately been discussed with increasing emphasis. Some remarks regarding 2,3 DPG-levels of stored blood and viscosity changes after volume replacement are added.