| Prostanoids: early mediators in the secondary injury that develops after unilateral pulmonary contusion. | |
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MedLine Citation:
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PMID: 10338399 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We have previously shown a sequence of events after unilateral pulmonary contusion that suggests the release of blood-borne prostanoid mediators and that culminates in refractory bilateral pulmonary failure. PURPOSE: To determine the role of platelet-derived thromboxane and endothelial-derived prostacyclin in the primary and secondary injury after unilateral blunt chest trauma, and to determine whether pretreatment with the cyclooxygenase inhibitor indomethacin alters the progression of secondary injury. METHODS: Anesthetized, ventilated (FIO2 = 0.50) pigs received a unilateral, blunt injury to the right thorax (n = 20) or sham injury (n = 5) and were monitored for 24 hours. Either indomethacin (5 mg/kg i.v.; n = 10) or its saline vehicle (n = 10) were administered 15 minutes before injury. Serial bronchoalveolar lavages of each lung were analyzed for protein and neutrophil (polymorphonuclear neutrophil (PMN)) content. RESULTS: Contusion caused profound hypoxemia; PaO2 partially recovered within 1 hour of injury to 50% of baseline. Thereafter, worsening hypoxemia required positive end-expiratory pressure. With indomethacin compared with vehicle, PaO2 was higher at any given level of positive end-expiratory pressure (p < 0.05). There was an early increase in serial bronchoalveolar lavage protein on the injured side (peak at 2 hours), with a delayed pulmonary capillary leak on the contralateral side (peak at 6 hours), which correlated with increasing PMN infiltration; this was reduced by 40 to 60% with indomethacin (p < 0.05). Thromboxane peaked within 1 hour after contusion at 800% baseline, then fell off rapidly. This peak preceded the maximal increase in permeability and was completely blocked by indomethacin. Prostacyclin slowly rose to 300% baseline by 3 hours and remained elevated; this change was blocked by indomethacin for 18 hours. CONCLUSIONS: Contusion of the right thorax induced a delayed pulmonary capillary leak in the left lung, which reflects a progressive secondary inflammatory response. Elevations in thromboxane and prostacyclin preceded progressive bilateral PMN infiltration. Indomethacin blocked thromboxane and prostacyclin and attenuated, but did not prevent, the progression to pulmonary failure. Overall, these data suggest that prostanoids are released soon after unilateral contusion and initiate an inflammatory response in both lungs that is sustained by PMN infiltration. |
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Authors:
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K A Davis; T C Fabian; M A Croce; K G Proctor |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: The Journal of trauma Volume: 46 ISSN: 0022-5282 ISO Abbreviation: J Trauma Publication Date: 1999 May |
Date Detail:
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Created Date: 1999-06-08 Completed Date: 1999-06-08 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 824-31; discussion 831-2 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, University of Tennessee, Memphis, USA. kdavis3@luc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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6-Ketoprostaglandin F1 alpha
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blood Animals Anoxia / etiology, therapy Bronchoalveolar Lavage Fluid / cytology Capillary Permeability Contusions / blood, complications, physiopathology* Cyclooxygenase Inhibitors / pharmacology Epoprostenol / blood, physiology Hemodynamics Hydrocortisone / blood Indomethacin / pharmacology Inflammation Mediators / physiology* Leukocytes / pathology Lung / blood supply, pathology Lung Injury* Positive-Pressure Respiration Prostaglandins / physiology* Swine Thromboxane B2 / blood, physiology |
| Chemical | |
Reg. No./Substance:
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0/Cyclooxygenase Inhibitors; 0/Inflammation Mediators; 0/Prostaglandins; 35121-78-9/Epoprostenol; 50-23-7/Hydrocortisone; 53-86-1/Indomethacin; 54397-85-2/Thromboxane B2; 58962-34-8/6-Ketoprostaglandin F1 alpha |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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