The effect of hemorrhagic shock on pulmonary vascular permeability to plasma proteins

The right (RTD) and left thoracic ducts (LTD) of dogs were cannulated to determine, respectively, pulmonary and abdominal visceral transvascular protein and fluid dynamics following hemorrhagic shock and reinfusion. One half of the shocked dogs, termed "shock sensitive" (SS), demonstrated a rapidly falling mean aortic blood pressure and a fivefold to tenfold increase in the RTD lymph flow rate, whereas the others, termed "shock insensitive" (SI), demonstrated relatively stable mean aortic blood pressures and RTD lymph flow rates. The L TD lymph flow rate was unchanged in both SI and SS groups. The pulmonary artery and left atrial pressures did not rise in shocked dogs. The lymph:plasma concentration ratios for albumin and globulin were elevated in both ducts, but were more marked in the RTD. The fluxes of albumin and globulin in the RTD were elevated in SS, but were unchanged in SI. The protein fluxes in the LTD were unchanged in both SI and SS. Gravimetrically determined pulmonary interstitial water was not increased in either SI or SS. Initial RTD lymph-plasma equilibration rates for RISA were calculated and demonstrated a sixfold increase in SS over controls but were unchanged in SI. No increases in the initial LTD lymph-plasma equilibration rates occurred in either the SI or SS group. Effective pulmonary vascular reflection coefficients and effective permeability-area products for albumin were calculated for SI and SS relative to controls. These data support the conclusion that an increase in permeability occurs in the pulmonary vasculature of dogs which die rapidly following hemorrhagic shock and reinfusion. Some considerations of the data relative to fluid and albumin administration in adult acute respiratory insufficiency are discussed.