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Am J Physiol Lung Cell Mol Physiol 280: L1233-L1241, 2001;
1040-0605/01 $5.00
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Vol. 280, Issue 6, L1233-L1241, June 2001

Pathophysiological analysis of combined burn and smoke inhalation injuries in sheep

Kazutaka Soejima1, Frank C. Schmalstieg2, Hiroyuki Sakurai1, Lillian D. Traber3, and Daniel L. Traber3

1 Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan; and 3 Department of Anesthesiology and 2 Department of Pediatrics, University of Texas Medical Branch and Shriners Burns Institute, Galveston, Texas 77555-0591

We investigated the pathophysiological alterations seen with combined burn and smoke inhalation injuries by focusing on pulmonary vascular permeability and cardiopulmonary function compared with those seen with either burn or smoke inhalation injury alone. To estimate the effect of factors other than injury, the experiments were also performed with no injury in the same experimental setting. Lung edema was most severe in the combined injury group. Our study revealed that burn injury does not affect protein leakage from the pulmonary microvasculature, even when burn is associated with smoke inhalation injury. The severity of lung edema seen with the combined injury is mainly due to augmentation of pulmonary microvascular permeability to fluid, not to protein. Cardiac dysfunction after the combined injury consisted of at least two phases. An initial depression was mostly related to hypovolemia due to burn injury. It was improved by a large amount of fluid resuscitation. The later phase, which was indicated to be a myocardial contractile dysfunction independent of the Starling equation, seemed to be correlated with smoke inhalation injury.

pulmonary vascular permeability; lung edema formation; myocardial depression


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