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Comparison of lung vascular and epithelial permeability indices in the adult respiratory distress syndrome.
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1986
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Acute Lung InjuryAsthma99Mtc-dtpa ClearancePulmonary CareInflammatory Lung DiseaseLung InflammationRespiratory Distress Syndrome (Pulmonary Critical Care)Tobacco ControlSepsisPublic HealthSmoking Related Lung DiseaseAllergyLung VascularRespiratory Distress Syndrome (Neonatal Medicine)Pulmonary MedicineProtein FluxDtpa ClearanceLung CancerPulmonary DiseasePulmonary Vascular DiseaseEpithelial Permeability IndicesPhysiologyPulmonary PhysiologyLung MechanicsMedicine
Measurements of pulmonary clearance of inhaled 99mTc-DTPA and transvascular 113mIntransferrin flux were made in 12 patients with established ARDS and 14 volunteer control subjects (7 smokers and 7 nonsmokers). Smokers had significantly increased 99mTc-DTPA clearance (clearance rate constant, 3.6 +/- 0.8; mean +/- SEM) compared with nonsmokers (1.2 +/- 0.1). All patients with ARDS had increased clearance of 99mTc-DTPA (5.2 +/- 0.9), but the finding was nonspecific in that increased clearance overlapped with the findings in normal smokers. Protein flux in smokers (protein flux units, 0.0 +/- 0.2) was similar to that in nonsmokers (0.3 +/- 0.2). In 9 of the 12 patients with ARDS, protein flux was increased, and as a group (3.2 +/- 1.0) they differed significantly (p less than 0.01) from the combined smoking and nonsmoking control subjects (0.2 +/- 0.1, n = 14). The parameters of DTPA clearance and transvascular protein flux correlated well in the patients with ARDS (Spearman's rank correlation = 0.71, p less than 0.01). Although 99mTc-DTPA clearance is a sensitive technique in ARDS, a single study in this context does not allow a diagnostic conclusion because of its non-specificity. Abnormal protein flux appears to be more specific for ARDS but was not a universal finding in the patients studied.