Pulmonary Circulation in Acute Lung Injury in the Presence of Acute Poisoning by Toxic Substances
Objective: to evaluate the efficiency of therapy in patients with acute intoxication with neurotropic poisons and protracted hypoxia complicated by pneumonia under guidance of impedance study of pulmonary circulation and pulmonary hydration. Subjects and methods. Ninety-six patients with acute intoxication with neurotropic poisons were examined and treated. They were divided into 3 groups: 1) 60 patients without signs of acute lung injury (ALI); 2) 17 with ALI in whom impedance methods for diagnosis and therapy monitoring were used; 3) 19 with ALI who were treated without impedance study. Systemic and pulmonary circulation and pulmonary hydration were evaluated via the one-stage application of integral body rheography (IBR) by the procedure developed by M. I. Tishchenko, thoracic rheography (TRG) after B. B. Sramek, and integral two-frequency impedance study. Results. In patients with ALI, increased thoracic fluid was accompanied by the decreased differential rheogram amplitude, which suggested the diminished pulsating component of blood flow, but the higher amplitude ratio of the differential rheograms obtained at IBR and TRG indicated the presence of impaired regional pulmonary circulation. The patients with ALI, followed by evolving pneumonia had lower differential rheogram amplitudes measured by TRG; they tended to have higher thoracic fluid levels and lower ejection rates. Conclusion. In patients with acute severe intoxication with neurotropic poisons, the risk for ALI is determined by the severity of intoxication and the duration and depth of hypoxia. The development of a critical condition determines the degree of pulmonary hyperhydration that depends on the pattern of cardiovascular abnormalities (a fall of single cardiac performance and pulmonary microcirculatory disorders). Monitoring of blood circulatory and microcirculatory disorders determines the basic treatment options and outcome.