GENERALIZED VASCULAR-PERMEABILITY AND PULMONARY-FUNCTION IN PATIENTS FOLLOWING SERIOUS TRAUMA

It has been suggested that the adult respiratory distress syndrome (AR DS) is a manifestation of a generalized vascular permeability defect. Low-level urinary albumin excretion reflects changes in systemic vascu lar permeability in a variety of acute inflammatory conditions includi ng trauma. To test the hypothesis that impaired pulmonary function is associated with increased systemic vascular permeability, 44 trauma pa tients with Injury Severity Scores (ISS) ranging from 9 to 75 were stu died over 3 days. Urinary albumin was measured from admission and expr essed as the albumin/creatinine ratio (ACR). In 24 mechanically ventil ated patients mean inspired oxygen fraction (FIO2) and mean arterial o xygen tension (PO2) were used to calculate the PO2/FIO2 ratio. For eac h study day patients were divided into group I, mean FIO2 > 0.5; group II, mean FIO2 < 0.5; and group III, those breathing spontaneously. Du ring the first posttrauma period the log ACR and the PO2/FIO2 ratio we re inversely related (r = -0.712; p < 0.001), and the log ACR predicte d PO2/FIO2 independent of ISS (p = 0.001). The log mean ACR (SD) for g roups I and III were 34.0 (5.6) and 8.7 (2.9) mg/mmol, respectively (M ann Whitney p = 0.013). Following trauma, pulmonary dysfunction is ass ociated with increased vascular permeability in remote organs.