[Functional and morphological changes of the lung during shock]

Altered metabolism of phospholipids in the lung of rats with peritonitis

Pulmonary alterations after shock and sepsis, described clinically as shock lung or adult respiratory distress syndrome, are of great importance in intensive care. Pathogenetically an alteration of the surfactant system of the lung is often discussed. Since phospholipids are constituents of lung surfactants, phospholipid metabolism is investigated in experimental peritonitis in rats in our laboratory. 15 hours after inducing a peritonitis, the lung incorporates more oleic acid than that in animals of the reference group. 33 hours after inducing peritonitis, the capacity of the lung to incorporate choline and fatty acids is markedly reduced, histologically the lungs represent morphological equivalents of the so-called shock lung at this time. Therefore we conclude, that an alteration of phospholipid metabolism with a diminished and/or altered synthesis of lung surfactant plays, at least in part, an important role in the pathogenesis of respiratory distress in sepsis and peritonitis.

The prognostic and therapeutic importance of changes in the CSF during the acute stage of brain injury

This research deals with the gaseous and biochemical changes in the cerebrospinal fluid and their effects on the cerebral blood flow and metabolic rates in the acute stage of brain injury. The results have shown that the lactacidosis in the CSF is of importance for prognosis and therapy, because of its central position in the course of pathophysiological mechanisms after a traumatic brain injury. Thus the lactate concentration in the CSF does give early information about the further clinical course. CSF acidosis itself can be influenced in a favourable way by intrathecal therapy with sodium bicarbonate.