Document Detail


Pulmonary activation of coagulation and inhibition of fibrinolysis after burn injuries and inhalation trauma.
MedLine Citation:
PMID:  21460745     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary coagulopathy is intrinsic to pneumonia and other forms of acute lung injury. We hypothesized patients with burn injuries and inhalation trauma to have similar alterations in pulmonary coagulation and fibrinolysis.
METHODS: We performed a prospective study on changes in pulmonary and systemic thrombin generation and fibrinolytic activity in patients with burn injuries and inhalation trauma requiring mechanical ventilation. Nondirected bronchial lavage was performed on alternate days. Patients requiring mechanical ventilation for nonpulmonary reasons who did not meet the North American European Consensus Conference criteria for acute lung injury functioned as control patients.
RESULTS: We studied 13 patients with burn injuries and inhalation trauma and 15 control patients. On admission, patients with burn injuries and inhalation trauma showed a significant increase in thrombin generation in the airways compared with control patients, as reflected by increased lavage fluid levels of thrombin-antithrombin complexes and fibrin degradation products, and decreased lavage fluid levels of activated protein C and antithrombin. Simultaneously, burn patients showed a significant decrease in fibrinolytic activity, as reflected by decreased lavage fluid levels of plasminogen activator activity. Pulmonary coagulopathy persisted throughout the period of mechanical ventilation and was accompanied by similar changes in systemic coagulation and fibrinolysis. There was no significant correlation between changes in coagulation and fibrinolysis and the extent of burn injury.
CONCLUSIONS: Patients with burn injuries and inhalation trauma requiring mechanical ventilation show a distinct and sustained procoagulant and antifibrinolytic shift in the pulmonary compartment. Pulmonary coagulopathy could be an important therapeutic target in these patients.
Authors:
Jorrit J Hofstra; Alexander P Vlaar; Paul Knape; Dave P Mackie; Rogier M Determann; Goda Choi; Tom van der Poll; Marcel Levi; Marcus J Schultz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  70     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-08-05     Completed Date:  2011-10-31     Revised Date:  2012-05-16    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1389-97     Citation Subset:  AIM; IM    
Affiliation:
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Aged
Blood Coagulation Disorders / etiology*
Blood Coagulation Factors / analysis
Bronchoalveolar Lavage
Burns, Inhalation / complications*
Case-Control Studies
Female
Fibrinolysis*
Humans
Injury Severity Score
Linear Models
Male
Middle Aged
Netherlands
Pneumonia / etiology*
Prospective Studies
Respiration, Artificial
Risk Factors
Statistics, Nonparametric
Chemical
Reg. No./Substance:
0/Blood Coagulation Factors
Comments/Corrections
Comment In:
J Trauma Acute Care Surg. 2012 Apr;72(4):1121-2; author reply 1122-3   [PMID:  22491646 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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