To further investigate if the
pulmonary surfactant system is altered in acute parenchymal
lung injury of adults following
polytrauma we measured SP-A level and
phospholipid composition in 150 sequentially obtained lung lavage samples from poly-traumatized patients (n = 19) beginning at the day of
trauma and ending 18 days later or when the patient was extubated. Out of the 19 patients studied 10 had severe parenchymal
lung injury (ARDS), nine had moderate
lung injury. SP-A was measured using a two-monoclonal sandwich ELISA-assay.
Phospholipids were separated using high-performance liquid chromatography and their composition was calculated by comparison with standard
phospholipid mixtures. We found immunoreactive SP-A concentrations ranging from 0.1 micrograms ml-1 to 8.5 micrograms ml-1 lung lavage fluid obtained from all patients. The mean SP-A concentration in patients who had severe parenchymal
lung injury (ARDS) was 1.06 +/- 0.16 micrograms ml-1 lavage fluid, the mean concentration in patients who had only moderate parenchymal
lung injury was 1.92 +/- 0.18 micrograms ml-1 lavage fluid. Both concentrations were lower than in healthy controls (2.74 +/- 0.3 micrograms ml-1 lavage fluid; n = 12). In patients who had moderate
lung injury the SP-A level normalized, but in patients who had severe
lung injury the SP-A level remained low during the timespan examined. SP-A alterations did not correlate to changes in
phospholipid composition as determined in lung lavage samples of individual patients. We conclude that alveolar SP-A concentrations decrease in polytraumatized patients who have acute parenchymal
lung injury soon after the
trauma occurs.(ABSTRACT TRUNCATED AT 250 WORDS)