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The Japanese journal of surgery

, Volume 7, Issue 4, pp 223–229 | Cite as

Disseminated intravascular coagulation in the pathogenesis of adult respiratory distress syndrome: 2. Experimental study

  • Ryo Ogawa
  • Yutaka Takano
  • Tatsushi Fujita
Article

Abstract

The role of disseminated intravascular coagulation (DIC) in the pathogenesis of adult respiratory distress syndrome (ARDS) was studied in the experimental animals. ARDS was simulated in dogs by the administration of various doses of Escherichia coli endotoxin (Difco). The alveolar surface activity in the group which recived lethal dose of endotoxin (3 mg/kg) exhibited no significant alterations with mild pulmonary insufficiency and little pathologic change five hours after the induction of shock. On the other hand, a significant decrease in alveolar surface activity was found to develop in the group which received sublethal dose of endotoxin (1 mg/kg) accompanying enlarged alveolar-arterial oxygen tension differences (A-aDO2) and elevated pulmonary vascular resistance after 24 hours. These changes occurred concomitantly with pathologic findings of DIC, interstitial edema and atelectasis. The disturbance in ventilatory function observed in prolonged shock appeared to be related to the impairment of pulmonary microcirculation caused by DIC and subsequent hypoxia of lung tissue which led to a loss of alveolar surfactant.

Key Words

Adult respiratory distress syndrome disseminated intravascular coagulation endotoxin shock alveolar surface activity pulmonary vascular resistance 

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References

  1. 1.
    Ashbaugh, D.G., Bigelow, D.M., Pety, T.L. and Levine, B.E.: Respiratory distress syndrome in adults,Lancet 2: 319–323, 1967.PubMedCrossRefGoogle Scholar
  2. 2.
    Bergentz, S.E., Lewis, D. and Ljungqvist-Malmo, U.: Die Lunge im Schock: Throbocyten anhaeufung nach Trauma und intravasale Geringung,Langenbech Arch. Chirur. 329: 659–670, 1971.Google Scholar
  3. 3.
    Blaisdell, F.W., Lim, R.C. and Stallone, R.J.: The mechanism of pulmonary damage following traumatic shock,Surg. Gynecol. Obstet. 130: 15–22, 1970.PubMedGoogle Scholar
  4. 4.
    Blaisdell, F.W. and Scholobolm, R.M.: The respiratory distress syndrome: A review,Surgery 74: 251–262, 1973.PubMedGoogle Scholar
  5. 5.
    Clements, J.A., Husted, R.F., Johnson, R.P. and Gribetz, I.: Pulmonary surface tension and alveolar stability,J. Appl. Physiol. 16: 444–452, 1961.PubMedGoogle Scholar
  6. 6.
    Gribetz, I., Frank, N. and Avery, M.L.: Static pressure-volume relations of excised lungs of infants with hyaline membrane disease of newborn and stillborn infants,J. Clin. Invest. 38: 2168–2175, 1959.PubMedCrossRefGoogle Scholar
  7. 7.
    Gruenwald, P.: A numerical index of the stability of lung expansion,J. Appl. Physiol. 18: 665–667, 1963.Google Scholar
  8. 8.
    Hardaway, R.M.: Disseminated intravascular coagulation as a possible cause of acute respiratory failure,Surg. Gynecol. Obstet. 37: 419–423, 1973.Google Scholar
  9. 9.
    Henry, J.N., McArdle, A.H., Bounus, G., Hampson, L.G., Scott, H.J. and Gurd, F.N.: The effect of experimental hemorrhagic shock on pulmonary alveolar surfactant,J. Trauma 7: 691–726, 1967.PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson, J.W.C., Permut, S., Sipple, J.H. and Salem, E.S.: Effect of intra-alveolar fluid on pulmonary surface tension properties,J. Appl. Physiol. 19: 769–777, 1964.PubMedGoogle Scholar
  11. 11.
    Keith, R.G., Mahoney, L.J. and Garvey, M.B.: Disseminated intravascular coagulation; An important feature of fat emboli syndrome,Canad. Med. Assoc. J. 105: 74–79, 1971.PubMedGoogle Scholar
  12. 12.
    Marcus, A.J.: Heparin therapy for disseminated intravascular coagulation,Amer. J. Med. Sci. 264: 365–366, 1972.PubMedGoogle Scholar
  13. 13.
    Ogawa, R., Kimura, T., and Fujita, T.: Disseminated intravascular coagulation in the pathogenesis of adult respiratory distress syndrome: 1. Clinical study,Jap. J. Surg. 7: 139–144, 1977.CrossRefGoogle Scholar
  14. 14.
    Peer, R.M. and Schwarz, S.I.: Development and treatment of post-traumatic platelet trapping,Ann. Surg. 181: 447–451, 1975.PubMedGoogle Scholar
  15. 15.
    Pety, T.L. and Ashbaugh, D.G.: The adult respiratory distress syndrome, clinical features, factors influencing prognosis and principle of management,Chest 60: 233–239, 1971.Google Scholar
  16. 16.
    Pierce, L.E.: Disseminated intravascular coagulation,Amer. Fam. Phys. 7: 118–125, 1973.Google Scholar
  17. 17.
    Robb, H.J., Margulis, R.R. and Jabs, C.M.: Role of pulmonary microembolism in the hemodynamics of endotoxin shock,Surg. Gynecol. Obstet. 135: 777–783, 1972.PubMedGoogle Scholar
  18. 18.
    Robinson, A.J., Holcroft, J.W., Olcott, C. and Howard, H.L.: Pulmonary and coagulation changes in tourniquet shock,J. Surg. Res. 19: 65–70, 1975.PubMedCrossRefGoogle Scholar

Copyright information

© The Japan Surgical Society 1977

Authors and Affiliations

  • Ryo Ogawa
    • 1
  • Yutaka Takano
    • 1
  • Tatsushi Fujita
    • 1
  1. 1.Department of AnesthesiologyGunma University School of MedicineMaebashiJapan

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