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Acute Pulmonary InsufficiencyTreatment in Vietnam Casualties
COL James P. Geiger, MC, USA;
LTC Isaac Gielchinsky, MC, USA
AMA Arch Surg. 1971;102(4):400-405.
Abstract
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Acute pulmonary insufficiency was observed in nonthoracic trauma, hemorrhagic shock, fat embolism, blast injury, pulmonary contusion, thermal burns, and sepsis. In the period July 1969 through June 1970 this syndrome was successfully reversed in 21 casualties in Vietnam varying in ages from 10 to 45 years. All manifested marked respiratory distress or hypoxemia and improved dramatically on a program of therapy that was developed to counteract each of the pathophysiologic changes thought to occur in this syndrome. Regardless of the immediate precipitating etiology, a number of common factors were found to be present: pulmonary hypertension, capillary obstruction with increased permeability and fluid extravasation, and pulmonary shunting. The therapeutic program consisted of (1) fluid restriction consistent with adequate resuscitation, (2) diuretics, (3) controlled positive pressure ventilation, (4) steroids, (5) heparin sodium, (6) antibiotics, (7) chlorpromazine hydrochloride, and (8) sedation. This regimen was effective in 21 out of 25 cases (86%) treated and is in marked contrast to the previous fatality rates of 50% to 90%.
Author Affiliations
Washington, DC; Phoenixville, Pa
From the Thoracic and Cardiovascular Surgery Service, Walter Reed General Hospital, Washington, DC (Dr. Geiger); and the Thoracic Surgery Service, Valley Forge General Hospital, Phoenixville, Pa (Dr. Gielchinsky).
Footnotes
Accepted for publication Dec 30, 1970.
Read before the 78th annual meeting of the Western Surgical Association, Colorado Springs, Colo, Nov 21, 1970.
Reprint requests to Thoracic Surgery Service, Walter Reed General Hospital, Washington, DC 20012 (Dr. Geiger).
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