Effect of lung contusion on surfactant composition in multiple-trauma patients

Objective: The aim of this study was to investigate alterations of the surfactant system in multiple-trauma patients (MTP) with lung contusion and the influence of single- or multiple-organ dysfunction syndrome (OF/MOF) on the surfactant system, Setting: University hospital, trauma-intensive care unit, Design: Prospective, nonrandomized study, Methods: MTP with an Injury Severity Score > 19 points have been recorded prospectively since 1992. Bronchoalveolar lavages were obtained daily either until day 14 or extubation, Three groups of MTP were compared: not: MTP, no lung contusion (n = 14); LuCo-: MTP, lung contusion, no OF/MOF (n = 17); LuCo+: MTP, lung contusion, with OF/MOF (n = 10), Also, surfactant samples of 11 healthy volunteers (Con) were investigated and compared with MTP. All data were presented as mean +/- SEM. Statistical analysis were performed using programs of SPSS 6.0.1. (univariate ANOVA, Fisher's Exact Test, p < = 0.05), Results: There were no differences in sex and age, Injury Severity Score was significantly impaired in group LuCo+ (44 +/- 4), compared with groups not (31 +/- 3) and LuCo- (34 +/- 3), Group not showed no statistical differences for lung function, total protein, and total phospholipid content of the bronchoalveolar lavage compared with group LuCo-, Furthermore, the relative content of phosphatidylcholine and phosphatidylglycerol in total phospholipids and surfactant-associated protein A were not significantly altered compared with group LuCo-, Lung function in group LuCo+ was significantly impaired and led to hypoxemia on the day of trauma, Total protein content and total phospholipids were significantly elevated in group LuCo+ compared with groups not and LuCo- on the first day, Also, the relative content of phosphatidylcholine was significantly increased in group LuCo+ up to day 4, compared with groups not and LuCo-, In comparison with groups not and LuCo-, a significant decrease of the relative content of phosphatidylglycerol was obtained in group LuCo+ up to day 7. The surfactant-associated protein A was increased in group LuCo+ during the whole observation time, compared with the other groups, Conclusions: Multiple trauma leads to alterations in the surfactant system, The composition of surfactant was not further influenced by lung contusion alone, Only MTP with OF/MOF during the intensive care unit treatment showed significant alterations in surfactant composition and a decrease in lung function.