After a
thoracotomy, twenty-one skeletally mature dogs were randomly assigned to one of three groups. Unilateral pulmonary
contusion alone was produced in Group 1 (seven dogs); pulmonary
contusion and
fat embolism, in Group 2 (seven dogs); and
fat embolism alone, in Group 3 (seven dogs). Pulmonary
contusion was produced by standardized compression of the left lung with a piezoelectric force transducer.
Fat embolism was produced by femoral and tibial reaming followed by pressurization of the intramedullary canals. Cardiac output, systolic blood pressure, peak airway pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, partial pressure of arterial
oxygen, and partial pressure of
carbon dioxide were monitored for all groups. From these data, several outcome parameters were calculated: total thoracic compliance, alveolar-arterial
oxygen gradient, and ratio of partial pressure of arterial
oxygen to fractional inspired
oxygen concentration. All of the dogs were killed after eight hours, and tissue samples were obtained from the brain, kidneys, and lungs for histological analysis. Lung samples were assigned scores for
pulmonary edema (the presence of fluid in the alveoli) and
inflammation (the presence of neutrophils or hyaline membranes, or both). The percentage of the total area occupied by fat was determined.
RESULTS: Pulmonary
contusion alone caused a significant increase in the alveolar-arterial
oxygen gradient but only after seven hours (p = 0.034).
Fat embolism alone caused a significant transient decrease in systolic blood pressure (p = 0.001) and a significant transient increase in pulmonary arterial pressure (p = 0.01) and pulmonary capillary wedge pressure (p = 0.015).
Fat embolism alone also caused a significant sustained decrease in the ratio of partial pressure of arterial
oxygen to fractional inspired
oxygen concentration (p = 0.0001) and a significant increase in the alveolar-arterial
oxygen gradient (p = 0.0001). The combination of pulmonary
contusion and
fat embolism caused a significant transient increase in pulmonary capillary wedge pressure (p = 0.0013) as well as a significant sustained decrease in partial pressure of arterial
oxygen (p = 0.0001) and a significant decrease in systolic blood pressure (p = 0.001) that lasted for an hour. Pulmonary
contusion followed by
fat embolism caused a significant increase in peak airway pressure (p = 0.015), alveolar-arterial
oxygen gradient (p = 0.0001), and pulmonary arterial pressure (p = 0.01), and these effects persisted for five hours. Total thoracic compliance was decreased 6.4 percent by pulmonary
contusion alone, 4.6 percent by
fat embolism alone, and 23.5 percent by pulmonary
contusion followed by
fat embolism. The ratio of partial pressure of arterial
oxygen to fractional inspired
oxygen concentration was decreased 23.7 percent by pulmonary
contusion alone, 52.3 percent by
fat embolism alone, and 65.8 percent by pulmonary
contusion followed by
fat embolism. The mean
pulmonary edema score was significantly higher with the combined injury than with either injury alone (p = 0.0001). None of the samples from the lungs demonstrated
inflammation.
Fat embolism combined with pulmonary
contusion resulted in a significantly greater mean percentage of the area occupied by fat in the noncontused right lung than in the contused left lung (p = 0.001); however, no significant difference between the right and left lungs could be detected with
fat embolism alone. The mean percentage of the glomerular and cerebral areas occupied by fat was greater with
fat embolism combined with pulmonary
contusion than with
fat embolism alone (p = 0.0001 and p = 0.01, respectively). (ABSTRACT TRUNCATED)