1987 Volume 18 Issue 2 Pages 231-244
Cardiorespiratory alterations during the 7-day period after injury were evaluated in 83 multiple trauma patients with severe chest injury. In 53 patients without severe head injury, the degree of cardiorespiratory responses were proportional to the grade of the injury severity score. The most striking physiological changes during the first 3 days were elevated pulmonary vascular resistance index and decreased right heart function due to pulmonary vascular microembolism and cardiac contusion. Also, decreases in pulmonary oxygenation and oxygen delivery were noted. In 27 patients with severe head injury, systemic hypertension, elevated systemic vascular resistance index, low cardiac output, and decreased oxygen delivery had persisted until brain death developed. Those physiological changes resulted from increased sympathetic nervous activity and hypovolemia induced by the administration of osmotic diuretics. In 13 patients who had developed posttraumatic respiratory failure due to pulmonary contusion, 2 hour-infusion of prostaglandin Ei in the right atrium significantly improved right cardiac function, pulmonary oxygenation, oxygen delivery, and urine output. It is concluded that multiple trauma patients with severe chest injury should be carefully monitored and aggressively managed so as to maintain physiological parameters at the optimal values. Also, it is suggested that prostaglandin E_1 is a drug of choice for treating trauma patients with acute respiratory failure, and possibly for those with multiple systems organ failure.
