Prevention of adult respiratory distress syndrome with plasminogen activator in pigs

• Published in: Critical care medicine Vol. 18; no. 12; p. 1413
• Main Authors: Hardaway, R M, Williams, C H, Marvasti, M, Farias, M, Tseng, A, Pinon, I, Yanez, D, Martinez, M, Navar, J
• Format: Journal Article
• Language: English
• Published: United States 01.12.1990
• Subjects: Animals; Blood Gas Analysis; Body Temperature; Disseminated Intravascular Coagulation - blood; Disseminated Intravascular Coagulation - complications; Disseminated Intravascular Coagulation - etiology; Female; Fibrinogen - analysis; Hemodynamics; Infusions, Intravenous; Male; Muscles - injuries; Partial Thromboplastin Time; Platelet Count; Prothrombin Time; Respiratory Distress Syndrome, Adult - drug therapy; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Swine; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - therapeutic use; Urokinase-Type Plasminogen Activator - administration & dosage; Urokinase-Type Plasminogen Activator - therapeutic use; Wounds and Injuries - complications; Wounds and Injuries - physiopathology
• ISSN: 0090-3493
• DOI: 10.1097/00003246-199012000-00021

Death from traumatic shock has been associated with loss of blood externally or internally. However, many patients die after trauma, even though blood volume restoration is adequate. Death is often due to pulmonary failure (adult respiratory distress syndrome [ARDS]). Death and ARDS have been associated with disseminated intravascular coagulation (DIC) and microclots in the lungs. Dissolution of the microclots after trauma can be achieved by activation of endogenous plasmin. Nine pigs were anesthetized for 48 h. Trauma was administered by 60 standard blows to each thigh resulting in a bruise of muscle but no skin, bone, or major vessel injury. Nutrition and respiration were maintained at normal levels. All nine pigs died with severe lung pathology and low PaO2. Ten other traumatized pigs were treated with a plasminogen activator iv 4 h after trauma. Five of these were treated with tissue plasminogen activator (tPA) and five with urokinase. All treated pigs survived 48 h and maintained a normal PaO2. Autopsy showed minimal lung pathology.