ABSTRACT
To the best of our knowledge, no case of ether-induced acute respiratory distress syndrome (ARDS) has been published as yet. A 36-year-old female developed pneumonitis which showed all the characteristics of a chemical-associated ARDS due to intravenous self-administration of ether: the hemodynamic investigation demonstrated a normal blood flow pattern with low left-heart filling pressure while the anteroposterior roentgenogram evidenced disseminated bilateral lung edema. Advanced symptomatic respiratory support including inhaled nitric oxide and steroidal anti-inflammatory use was the treatment of choice.
Subject(s)
Ether/poisoning , Respiratory Distress Syndrome/chemically induced , Solvents/poisoning , Adult , Catheters, Indwelling/adverse effects , Ether/administration & dosage , Female , Humans , Injections, Intravenous , Nitric Oxide/therapeutic use , Pulmonary Edema/chemically induced , Pulmonary Edema/diagnostic imaging , Radiography , Respiratory Distress Syndrome/therapy , Solvents/administration & dosage , Suicide, AttemptedABSTRACT
In this prospective study of 50 patients, 36 of whom developed the adult respiratory distress syndrome (ARDS), early and intense complement activation was demonstrated. These patients were at risk of the ARDS because of multiple injuries, major abdominal surgery, acute pancreatitis, severe burns, or disseminated intravascular coagulation. Abnormal C3 consumption (as measured by the C3d/C3 ratio) and elevated plasma C5a-like activity (as measured by a leukocyte aggregation assay) were associated with, respectively, 84 and 86% of cases of ARDS. Both tests were more sensitive indicators of complement consumption than were assays of total hemolytic complement activity (CH50) or total C3. The C3d/C3 ratio showed a close, inverse correlation with CH50 in 47 healthy subjects, and was increased in 12 control patients after minor surgery. The C5a-like activity was found only in patients at risk of ARDS; it was highly associated with clinical conditions that predispose to the ARDS, but it cannot be considered as a real predictor of ARDS occurrence in these patients. Sequential samples from both sides of the pulmonary circulation showed initial pulmonary clearance followed by the release of C5a-like activity. No simultaneous changes in C3 levels were found, suggesting the possible presence of modulating factors. These observations suggest that other factors (e.g., hypoxia and metabolic cascades) may influence the development of ARDS.
Subject(s)
Complement Activation , Respiratory Distress Syndrome/physiopathology , Complement C3/analysis , Complement C5/analysis , Complement C5/metabolism , Hemolysis , Humans , Pulmonary Circulation , Respiratory Distress Syndrome/blood , RiskABSTRACT
Intense rises of plasma arachidonate have been observed in men in various physiopathological circumstances: in old patients who suffered from hypertension, in patients before and after various surgical procedures, in patients submitted to cardiopulmonary bypass with extracorporeal circulation or to abdominal aortic prosthesis, and in young volunteers or patients submitted to a strain test on bicycle ergometer. The plasmatic arachidonate concentration sometimes reached values ten times higher than the maximal normal value of 5 micrograms/ml plasma registered in 157 controls. These important arachidonate releases have been related to stress (pain, operative or anticipation stress).
