Prostanoid release and lipid peroxidation in patients suffering from thoracic trauma

There is compelling data from recent clinical studies on the impact of dama ge to the lung on the fate of traumatized patients. The lung reacts with a tremendous release of inflammatory mediators, but, on the other hand, this organ's ability in inactivating those factors is simultaneously attenuated. What is more, it is well known, that there often are no clinical signs of pulmonary dysfunction despite severe lung injury in the early posttraumatic phase. Therefore, in this prospective clinical study the following questio ns were addressed: (i) Is there any difference of the patients' lung respon se whether or not the (poly)trauma is associated with damage to the chest, (ii) either in the early or the late posttraumatic phase, and (iii) is ther e any marker that may prove to be a (significant) predictor of poor overall outcome? Methods: Upon approval of the local IRB/EC, 35 patients (pts) were enrolled who suffered from multiple injuries. The first blood samples were drawn at admission, then every two hours and in daily intervals. The plasma concent rations of following mediators were analyzed: prostanoids (PGI(2), TxA2 PGE (2), PGF(2 alpha)) and products of O-2-radicals (malondialdehyde, conjugate d dienes). All values were calculated on the basis of the actual plasma pro tein content to eliminate fluid-induced dilution effects. Subsets of pts we re performed according to the different injury pattern: (i) pre-dominantly thoracic trauma (TX, n = 9); (ii) polytrauma with (PTX, n = 19), and (iii) without (PT, it = 7) damage to the lung. Results: As early as at admission, all pts revealed a severity-independent increase (p < 0.01) in most mediators' plasma levels. The pattern-related i nflammatory response was most pronounced in casualties who had experienced thoracic trauma irrespective of whether it was combined with polytrauma. Wi thin 1 to 3 days, the plasma levels of most mediators but PGE(2) and MDA (a ll pts) as well as PGF(2 alpha) (PTX-group) normalized. The reactions of th e lipid peroxidation products admitted of no group-differences, Conclusion: Although there was a pattern-related release of (most) prostano ids which was rather pronounced in polytrauma associated with damage to the lung, we failed in proving any predictive marker to specifically estimate outcome, so far.