Pathophysiology of acute lung injury in severe burn and smoke inhalation injury

This review article describes the pathophysiological aspects of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), induced by combined burn and smoke inhalation and examines various therapeutic approaches. The injury results in a fall in arterial oxygenation as a result of airwa...

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Bibliographic Details
Published in:Der Anaesthesist 2009-08, Vol.58 (8), p.805
Main Authors: Maybauer, M O, Rehberg, S, Traber, D L, Herndon, D N, Maybauer, D M
Format: Article
Language:ger
Subjects:
Acute Lung Injury - epidemiology
Acute Lung Injury - physiopathology
Bronchi - pathology
Bronchi - physiopathology
Burns, Inhalation - epidemiology
Burns, Inhalation - physiopathology
Humans
Pulmonary Alveoli - physiopathology
Pulmonary Circulation - physiology
Respiratory Distress Syndrome, Adult - epidemiology
Respiratory Distress Syndrome, Adult - etiology
Respiratory Distress Syndrome, Adult - physiopathology
Smoke Inhalation Injury - epidemiology
Smoke Inhalation Injury - physiopathology
Trachea - pathology
Trachea - physiopathology
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Summary:This review article describes the pathophysiological aspects of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), induced by combined burn and smoke inhalation and examines various therapeutic approaches. The injury results in a fall in arterial oxygenation as a result of airway obstruction, increased pulmonary transvascular fluid flux and loss of hypoxic pulmonary vasoconstriction. The changes in cardiopulmonary function are mediated by reactive oxygen and nitrogen species. Nitric oxide (NO) is generated by both inducible and constitutive isoforms of nitric oxide synthase (NOS). Recently, neuronal NOS emerged as a major component within the pathogenesis of ARDS. NO rapidly combines with the oxygen radical superoxide to form reactive and highly toxic nitrogen species such as peroxynitrite. The control of NO formation involves poly(ADP-ribose) polymerase and its ability to up-regulate the activity of nuclear transcription factors through ribosylation. In addition, present data support a major role of the bronchial circulation in the injury, as blockage of bronchial blood flow will also minimize the pulmonary injury. Current data suggest that cytotoxins and activated cells are formed in the airway and carried to the parenchyma.
ISSN:1432-055X
DOI:10.1007/s00101-009-1560-x