Pathomechanisms of lung injury in hemorrhagic shock
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Zakład Podstawowych Nauk Medycznych Śląski Uniwersytet Medyczny w Katowicach
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Jerzy Jochem   

Zakład Podstawowych Nauk Medycznych SUM w Katowicach, 41-902 Bytom, ul. Piekarska 18, tel. 032 397 65 30, faxL 032 397 65 42
Ann. Acad. Med. Siles. 2009;63:93-99
Hemorrhagic shock provokes a number of changes in the lungs, which may result in acute respiratory distress syndrome (ARDS). The underlying cause is a multiorgan inflammation also affecting the lungs. Inflammatory mediators involved in pathomechanisms of pulmonary damage are mainly produced in the intestine during shock-induced ischaemia. They are responsible for accumulation of inflammatory cells in the lung tissue, thickening of alveolar septa, and oedema due to increased microvascular permeability. Overexpression of adhesion molecules on pulmonary epithelial cells leads to enhanced interaction with inflammatory cells. This, in turn, accelerates epithelial apoptosis, thus causing epithelial cell dysfunction. Priming neutrophils, capable of generating respiratory burst, are characterized by prolonged survival resulting in longer duration of pulmonary inflammation. Experimental data suggest that during hemorrhagic shock, lung tissue can be protected by hypertonic (7.5%) NaCl solution, antioxidants (N-acetylcysteine, vitamin E), allopurinol, 17β-estradiol as well as neutrophil elastase inhibitor – sivelestat. Studies are being carried out with the use of surfactant protein A, nitrous oxide, and small interfering Fas-RNA in hemorrhagic shock.
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