INDEX

Note: page numbers in italics refer to tables, those in bold refer to figures

A-a gradient 255-6 Abscess formation 65 N-Acetylcysteine 185, 514 N-Acetylglucosarnine 239-40 Acidosis

intracellular 400 metabolie 400, 402

Actin assembly 74 a-Actinin 125 Acute inflammatory response 50

media tors and NOS gene expression 498

Acute lung injury 5, 317 air-capillary barrier permeability

200 airway resistance 258-9 alveolar flooding 348, 349-50 alveolar fluid clearance 352 animal models 70, 72, 304--5 arterial oxygenation 350 associated clinieal syndromes 28 barotrauma 350 catecholarnines 351-2 compliance 256-7 components 319 definition 32, 319 diversity 26-32 early detection 508 endothelial damage index 349 endotoxin 72, 78

tolerance 77 experimental models 275, 276--81 gas exchange 255-6 host defense 233 host response to bacteria 240 hypoxie pulmonary

vasoconstrietion loss 510 ICAM-1207 inflammation mediators 507 intensity 350-1 lung volume 254--5 lung water 253-4, 351 management 393 mieromechanics 395-6 rnicrovessel inflammatory injury

26 neutrophils

recruitment 74

role 72 outcome 31-2 oxygen radieal mediation 351 pathogenesis 26-30 pathophysiology 495 pressure targeted approach to

ventilating 400-1 proteases 75 protein leakage 200-1 Pseudomonas aeruginosa induced

351,353 pulmonary defense impairment

240-2 pulmonary edema fluid 348,

349-50 pulmonary hypertension 303-4 pulmonary mechanies 256-9 pulmonary physiology 251-9 remote organ damage 324 secondary infections 233 spectrum 27 stiffness 395 surfactant abnormalities 202 tracheal gas insufflation

effectiveness 403-4 vasoactive agent release 26 see also Lung injury

Adenosine 511 Adhesion

firm 116, 117 rolling 116, 117, 119, 128

L-selectin inhibition 120 Adhesion molecules 55,101,115-16,

207 expression 101 immunoglobulin superfamily

126-8 integrins 122-6 transmembrane glycoprotein 207

Adrenergie nerve fibers 234 Aerobic life 169, 174 Air embolism 5 Air trapping, controled 456 Airway nerves 234 Airway pressure 257 Airway resistance 258-9 Akadaie acid 103 Albumin clearance 252

Aldosterone 484, 488 Aigorithms 467 Alkylacylglycerol (AAG) 106 Alveolar capillary

integrity breakdown 14 shock lung 38-9, 40

Alveolar collapse 205 focal 198

Alveolar contraction 205 Alveolar damage

diffuse 199 proliferative phase 205

Alveolar dead space 255 tracheal gas insufflation 402-4

Alveolar edema, excess fluid drainage 483

Alveolar epithelial barrier 200-1, 345

active ion transport system 346-7, 348

alveolar fluid clearance 346 edema in lung injury 348 injury 348

in acute lung injury 350 intensity 350, 351 prevention/treatment 353

ion transport 200-1 lung fluid balance 345-8 passive movement prevention 348 permeability 348, 350 protein leakage 200-1 type specific antibody presence

353,354 Alveolar epithelial cells

alveolar lining fluid 268 changes in ARDS 198 gross damage 198 injury 365 Na + transport 484 neutrophil influx effects 199 tight junctions 38, 198

Alveolar epithelial type I cells 198 Alveolar epithelial type 11 cells 150,

197 antioxidant enzymes 198 damage 273

effects on phospholipids 274 differentiation 215

526 Index

Alveolar epithelial type 11 cells (contd.)

in to type I cells 198 Alveolar epithelial type 11 cells

(contd.) DNA synthesis stimulation 205 dysfunction 273 functional water channel 347 lamellar bodies 197 proliferation in lung injury 348 replication 215 sodium uptake 347 surfactant

component deficiency 270, 273 resynthesis 269 secretion 198 synthesis 201

surfactant secretion 352 tight junctions 200 tumor necrosis factor 200 turnover 198 ultrastructure 267 uteroglobin synthesis 204

Alveolar flooding 255, 348, 349-50, 481

Alveolar fluid c1earance

catecholamine effects 352 from human lung 346--8

movement regulation 482-3 reabsorption 350, 351 removal346 sodium transport 346-7

Alveolar gas equation 256 Alveolar interstitial thickening 205 Alveolar leak syndrome 207 Alveolar lining fluid

alveolar-capillary injury 273 total protein content 273

Alveolar overdistension CO2 retention 401 IVOX risk 445

Alveolar pressure limits 399 Alveolar septae, ARDS proliferative

phase 482 Alveolar volume, minimum 397 Alveolar wall, junctional 395 Alveolar-arterial oxygen tension

gradient 255-6, 510 Alveolar-capillary barrier 251-3

99mTc-DTPA c1earance 252-3 albumin c1earance 252 damage 13, 153

intra-alveolar exudate 155 double isotope technique for

permeability 252 injury 273 net fluid flux to interstitium 252 permeability assessment 252-3

physiology 251-2 Alveolar-capillary membrane

diffuse damage 91 disruption 215 fluid flux 325 IL-8 generation 92 inflammatory stimuli 89 integrity 30 overdistension 395

Alveolitis, n~utrophilic 87 Alveolus

mechanical stimulation 203 tidal stresses 398 ventilatory pressure excursion 397

Amiloride 102, 103 Amino sugar inhibition 61 Anaerobic organisms 169 Analysis 462, 463 Anti-CD18 514 Anti-inflammatory agents 508

therapy 50 Anti-tumor necrosis factor 326

antibody 512-13 antiserum 324

Antibiotics 238 Anticoagulation, ECMO 431-2 Antidiuretic hormone release 488 Antiendotoxin antibodies 511-12 Antigen presenting cells 235 Antileukoproteinase 150 Antilung serum 277, 279 Antioxidants 514

cell protection against oxidative damage 178-9

chain breaking 178-9 deficiencies 178-87 defined 178 fluid changes 185 see also Plasma antioxidants

Antiprotease 75 inactivation 74-5

cxj-Antiprotease 271 Antiproteinase 28 cx-Antiproteinase 189 cxj-Antiproteinase 167 cxj-Antitrypsin 75

inhibitors 146 APACHE 11 data base 384 APACHE 11 scores 384-5

admission 385 predictive power for mortality

385 APACHE 11 scoring system 381-2

mortality prediction 381, 382 APACHE III prognostic system 382 APACHE scoring system 381-2 Apoprotein

fetal lung immaturity 269-70 recombinant 276

surfactant 267-9 Apoptosis 57-9

ageing granulocytes 59---{)0 cell changes 58 glomerular remodeling in

nephritis 62 inflammation control 63-4 internuc1eosomal c1eavage of

chromatin 59 intracellular mechanisms 62 neutrophils 56, 57, 58, 60

c1earance mechanism 59 process 58-9 proto-oncogene expression 63 regulation of granulocyte by

external media tors 62-3 thymocytes 62 tissue remodeling 62

Arachidonic acid 187, 190 cascade 222 metabolites 106, 201

ARDS abnormal proteinase activity

154-5 acute phase 6, 7 alveolar-capillary barrier

disturbance 451 causes 8

direct 9 chemotactic gradient 115 chronic phase 6, 7, 8 c1assifica tion 8 c1inical signs 321 clinopathological phases 197 complications 5 definition 5-8,13-14,318-19

current 32 demographics 15-17 descriptions 3-4 development 25 diagnostic critera 13 epidemiology 319-20 etiology 384 evolution to MODS 323 expanded definition 385---{) experimental models with

surfactant administration 276-81

experimentally-produced lesions 199

fatality rate 17 features 5 fibroproliferative phase 513 fibroproliferative response 198 fluid management 325-6 hemodynamic management 325-6 incidence 14-15,21

predisposed group 15 indirect variety 9

infection management 326 models 278, 279, 320-1

inflammatory cell infiltrate 115 inflammatory model 321-3 intensive care 20, 21 long term sequelae 19 lung disease development 25 lung injury 167 management 324-6 microcirculation 323 mortality 21, 317

pneumonia 236 rate 167

multiple organ dysfunction syndrome cases 319-20

natural history 17-19 noncardiogenie pulmonary leak

200 non-pharmacological strategies 20 organ failure 320 organ-organ interaction 320,

323-4 outcome prediction 20 outcomes data 20 oxidant-antioxidant balance 75 oxidant induced 280 oxygen

delivery 337 in outcome 452 requirements 168

panendothelial injury 324 pathogenesis 8-10 pathophysiology 30, 320-4 patient management 325 pharmacological treatment/

prevention 20 pneumonia incidence 236 predietion with complement

components 70 predictors 16-17 predisposing conditions 17-18 predisposing factors 15-16 preventive / management

strategies 31 prognosis 167, 326 progression 5, 13 proliferative phase 198, 482 prone positioning of patients 395 proposed scoring system 387 recovery 49 research and c1inieal trials 451---{i3 resolution phase 198-9 risk factors 25, 271 saline lung lavage 277-8 secondary respiratory failure 323 sepsis 167

associa tion 6 severity 7-8, 18

supranormal oxygen delivery 325 surfactant alterations 271-5 surfactant replacement

clinical trials 281-5 therapy 276

survival31 computerized protocols 469 variability 452-5

survivors 33 systemic insult 324 treatment

effects on outcome 19-20 strategies 20, 484-7

ventilation 325---{i Arginine, analogs 298, 299 Arginine-NO pathway 496-8 L-Arginine/nitrie oxide pathway

manipulation 514-15 Arterial blood gas, maintenance of

normal 399 Artificial Lung Expanding

Compound (ALEC) 276, 276 late stage severe ARDS trial 284

Asbestosis 90, 91 Ascorbic acid 181, 185 Aspartie proteinases 139-40, 144-5 Aspergillus spp. 240 Aspiration, mortality 384 Aspirin 201 Atelectasis 4

congestive 5, 13, 37, 38 lung volume loss 255 pulmonary 8 reversal by PEEP 399 see also Microatelectasis

prevention Atelectatic induration 43 Atrial natriuretie factor 488 Auditory noise 453 Authoritarian paradigm 459---{i0 Auto-positive end expiratory

pressure (PEEP) 399, 401 see also Positive end expiratory

press ure (PEEP) Aventilatory mass flow 427 Azurophil granule 104, 146-7,

148 HLE concentration 152 release 152

ß-adrenergic agonists 347 Bacteremia 15 Bacterial adherence to epithelial

cells 238-9 Bacterial c1earance impairment

241 Bacterial translocation 77--8, 324 Barotrauma 396-7, 414-15

bronchopleural fistulae 414

Index 527

inhomogenous ventilation 414 pediatric patients 418 prevention 413 primary infection of lung 415 radiographie 394 underlying pulmonary disease

414-15 Basophils 149 bc1-263 Belief

decision making 459 influences 460 outcome data 459, 460

Beneficence 457, 458 decision making 458-9

Benevolent intention 457--8 Bias 463

differential 467 Bilirubin 181 Blood volume maintenance 338 Branhamella catarrhalis 237 Breathing mechanies 317 Bronchi

adhesed wall opening 395 physical pressure-induced

damage 395, 396 Broncho-alveolar lavage

fluid 187 protein leakage 200-1

Bronchogenic carcinoma 87 Bronchopleural fistulae 414 Bronchoscopy, fibreoptie 432 Bubble model of surfactant action

264-5 Buccal cells, sialic acid loss 239-40

C3 c1eavage 70 C5 c1eavage 70 C5a 51, 62

monocyte response 52 neutrophil aggregation 69 neutrophil chemotactic effects 52 neutrophil exposure 53 release 40

C5b-970,71 CAMP dependent kinase (PKA) 108 C-C family 89 c-myc expression 63 C-reactive protein, surfactant effects

274 C-X-C chemokines 92

supergene family 88 Ca2 +

priming role 107 voltage gated channels 301-2

[Ca2+ lj 62 Cadherins 207 Calcium antagonists 510 CAP3751

528 Index

Capillary permeability 200 stress fractures 396 transmural pressure 396 see also Alveolar capillary;

Pulmonary capillary Capillary endothelial membrane

injury modulation 396 injury prevention/treatment 353

Capillary endothelium 365, 496 Carbohydrate moieties 116 Carbonyls, plasma protein 189-90 Carcinoembryonic antigen (CEA)

126-7 Cardiac index, vasodilator effects

510 Cardiac index/02ER diagram

339--40, 340 Cardiac output

D02 337, 339 value 341

Cardiac tamponade, oxygen extraction capabilities 332, 333

Cardiac valvular lesions 499 Cardiolipin 266 Cardiopulmonary support systems,

extracorporeal 425 a-Carotene 181 Cartilage matrix protein 121 Cartilage-link 116 Catalase 75, 179, 185

activity 16 Catecholarnines, endogenous/

exogenous 351-2 Cathepsin 143, 144 Cathepsin B 143, 153 Cathepsin D 144-5 Cathepsin G 141, 145

alveolar-capillary barrier damage 153,154

endothelial cell detachment 153--4 expression on PMNs 152 in monocytes 148 PMNs 147 substrates 141

Cathepsin H 143 Cathepsin L 143, 145, 149 Cathepsin S 143, 145, 149 Cations 104 Causal inferences 463, 466 CD4 lymphocytes 235 CD8 lymphocytes 235 CD11b/CD18 53, 55 CD14 73, 74 CD18

adhesion responses by NCA 127 blocking 74

deficiency 128 monocyte retention 76

CD3661 CD43 116, 128 CD44 116, 127 CD66126 CD67126 Cell

apoptotic clearance 58 cascade 222, 223 damage limitation by blood flow

337 Cell adhesion moleeule 101, 205

receptors 205 Ceruloplasmin 75, 175, 183

ferroxidase activity 183--4 iron metabolism role 181 a-protease oxidative inactivation

action 185 proteolytic degradation 175

Chemiluminescence analysis of NO 502

Chemokines 29 Chemotaxins 235 Chest radiograph

acute lung injury 319 scoring 370-1

Chest radiography 361-71 digital 362 grids 361 portable 361-2 pulmonary edema differentiation

of types 369-70 radiographie abnormalities 362-8 ehest wall, external oscillation 420

CHIP28 functional water channel 347

Cholesterol, metabolism abnormalities 187

Cholinergic nerve fibers 234 Chromatin, internucleosomal

cleavage 59 Chylomicrons 181 Cigarette smokers

methemoglobinernia 500 surfactant 266-7

Cl- /HC03 - exchange 102, 103 Clara cells 150

uteroglobin synthesis 204 Clinical care, standardized 468 Clinical research elements 462 Clinical trials

alternative treatment strategies 464

analysis 462, 463 ARDS research 451 ~3 bias 454, 455 causal inferences 466 causation 463

concurrent control group 467 lack 460-1

control 462, 463, 466 crossover effects 464 design 463-70 double blinding 466-7 dropouts 466 error 464-5 ethical concerns 457-9 follow up data 466 inference 463 information input overload 456 interventional studies 463-5 level of inquiry definition 461 measurement 462, 463 n enrolled patients 465 observational studies 463-5 outcome 469-70 PCIRV 45~ predictive value of results 464 protocols 467-9 randornization 458, 466-7 reducing cointerventions 467-9 rescue therapy 457, 466 retrospective studies 455 signal-to-noise ratio for outcome

differences 453-5 standardization lack 455~0 ultimate clinical outcome 464 uncontrolled 460-1 validity

external 46~ internal 466

variable deterrninant numbers 456 CO2

extracorporeal removal 427-8 retention 400, 401

CO2 elimination augmented diffusion 411 efficiency 402 HFV 411, 412 tidal volume 411, 412 tracheal gas insufflation 402-3

Coagulation cascade 26 factor V 175 factor VIIa 516

Collagen 43 deposition in lungs 205, 368 interstitial 145 removal from alveolar spaces 156 type IV 146, 394 type V 146 type IX 146

7S Collagen 155 Collagenase 27, 115

activity in ECM remodeling 205 in eosinophils 149

interstitial 145, 149 lavage samples from ARDS

patients 274 substrates 145-6 type I 155 type Ir 155

Collagenase-3 143 Colonization 237-40

antibiotics 238 bacterial adherence to epithelial

cells 238-9 endotracheal intubation 237-8 gastric alkalinization 238

Colony stimulating factor inflammation 216, 219-20 LPS stimulation of macrophage

release 76 neutrophil priming 73

Complement fragments 71, 73, 235 hypothesis 69-71 regulatory proteins factor Band

H 121 Complement activation 16, 71, 72,

78 endotoxin 72 lung injury 69-70 neutrophil-dependent lung injury

70 Complement cascade 26

activation 69 at risk patients 71, 72 shock 40

Compliance acute lung injury 256-7 clinical application 258 dynamic 258 measurement 257 neuromuscular blockers 257

Computed tomography (CT) 371-3, 374

clinical application 371 densitometry 373 fibrosis of lung 373, 374 high resolution 371, 373 lung consolidation and patient

positioning 373, 374 lung functional measurements

372-3 morphological! functional

correlations 371-3, 374 objective assessment of

abnormalities 373 recovery phase of ARDS 371 regional density measurement 372

Concanavalin A 148 Connective tissue

activating peptide 111 (CTAP-l11) 88

deposition 367 lung repair 481

Constrictor responsiveness, mechanisms of loss 305-7

Continuous arteriovenous hemofiltration 487, 488

with dialysis 488 Control 462, 463

clinical trials 466 Copper

dietary absorption 174 free radical catalyst 174-5 release from ceruloplasmin 175

Corticosteroids 511 ARDS treatment 284-5

CR3 surface expression in neutrophils 125-6

Credible outcome data 459, 460 Critical care 451 Crossover treatment effects 464 Curosurf 285 Cyclo-oxygenase 515

blockade in pneumonia 306 Cycloheximide 62, 64 Cystatin 146 Cysteine proteinases 139-40, 143-4,

146 elastolytic activity 145 papains 143 pH range of activity 144

Cysteine switch model 142 Cysts, air space 368 Cytidine diphosphate-choline

pathway 202 Cytochalasin B 74 Cytochrome c 170 Cytochrome oxidase 179-80 Cytokines 10, 29, 85-6

alveolar epithelial type Ir cell stimulation 205

cascade 85---{), 222, 223 corticosteroid interactions 511 damaging effect blocking 512 fibroblast modulation 223 fibrogenic 43 fibroproliferative phase of ARDS

513 fibrosis control 216-22 glycosaminoglycan binding 222 inflammation control 216-22 inflammatory effector cell

recruitment 85-6 lung inflammation 451 manipulation 512-13 network 87, 90, 516 networking 85-6, 93-4

chemokine generation 93 proteoglycan bin ding 222

Index 529

pulmonary inflammation modulation 86-9

scarring media tors 222 Cytotoxic T lymphocytes 235

Da-nang lung 4, 37 Data

accuracy 463 follow up 466 precision 463 representativeness 463

Dazoxiben 515 Death, time to 15 Decision making

belief 459 beneficence 458-9 clinical 457

therapeutic paradigm 462 computerized protocols 468 credible data 458 ethica1459 signal-to-noise ratio of clinical

problem 458 therapeutic 460

Decorin 222 Descriptions of ARDS 3-4 Desferroxamine 172 Desmosine 16 Diffuse alveolar damage 37

causes 37 model 482, 483

exudative phase 481 interstitial component

proliferation 481 pathology 37-41 repair stage 42 vascular remodeling 42

Diffuse radiographic infiltration 5 Diffusion respiration 427 Diltiazem 307 Dipalmitoylphosphatidylcholine

(DPPC) 202, 263-4 structure 265 surfactant replacement therapy

275-6 synthetic 276, 277

Disordered physiology indices 384 Disseminated intravascular

coagulation 39 Diuretics, dry lung maintenance

338 DNA damage 191 D02 crit 332

see also Oxygen delivery (002) Dobutamine

use in therapy 338 V02 increase 337 V02 /D02 relationship 334, 336

Dopamine 489

530 Index

Double blinding 466--7 controled randomization 467

Drowning, near 5 Duty cyde extension 401

E5 therapy 512 E-cadherin 207 E-selectin 55, 74, 101, 116, 118

expression 120 glycoprotein ligand 119 NCA-160 role in binding 126 neutrophil migration 102 structure 118

Echocardiography 486 Eicosanoids 26, 74

ARDS patients 75 LPS stimulation of release 75, 76 production 106

Elafin 150 Elastance, see Compliance Elastase 27, 61, 65, 115

immunoglobulin deavage 241-2 inhibitor 271 microbial defense impairment

241 substrates 145 see also Human leukocyte elastase

(HLE) Elastin, proteinase substrate 145 Electrochemical sensor analysis of

NO 502, 504 Emphysema 365, 367

proteinase/ antiproteinase theory 64

pulmonary interstitial 414 pulmonary vascular compression

367 End expiratory lung volume,

maintenance 397-9 End inspiratory alveolar pressure

395 End inspiratory static airway

press ure 401 Endonuclease 59 Endopeptidase, see Proteinase Endothelial adhesive molecule

upregulation 55 Endothelial basement membrane

154 Endothelial ceIl 10

activation markers 18 adhesion molecules 513--14 granulation tissue 225 injury 108 leukocyte adhesion molecules 451 proteinase expression 150 recovery from injury 55

Endothelial injury, pneumococcal pneumonia 55

Endothelins 26, 302, 304, 516 vasoconstrictor response 304

Endothelium ß2-integrin media ted binding 124 LPS effects 76 neutrophil migration 102 permeability 251 pulmonary vascular control 298--9

Endothelium derived contracting factor 1 (EDCF-l) 301

Endothelium derived relaxing factor, see Nitric oxide (NO)

Endotoxemia 512 Endotoxic lipopolysaccharide 62 Endotoxin 72

acute lung injury 78 ARDS73--4

pathogenesis 71-8 complement activation 72

eicosanoid release 75 neutrophil priming 73 NOS gene expression 498 sepsis effects 511-12 sources 77-8 tolerance 77 Vo2/Do2 relationship 333

Endotracheal intubation 237--8 Endpoints 464 Enteral feeding 326 Enterobacteriaeeae 237 Eosinophil coIlagenase storage 149 Epinephrine 351-2 Epithelial basement membrane 154 Epithelial ceIls

cytoprotective mechanisrns 55 recovery from injury 55 respiratory 239, 240

Epithelial injury 197 alveolar type 11 ceIls 197 pathology 197-200 repair 197

Epithelial neutrophil activating factor 78 (ENA-78) 52, 88

Epithelium barrier function 18 fluid leakage barrier 251 protein permeability 252

Equipoise 459 Errors

hypothesis testing 464--5 type I (a error) 465 type 11 (ß error) 465

Eseheriehia eoli hypoxia effects on clearance 243 infection model 279

Ethics clinical trials 457-9 control groups 467

Exosurf 276, 277, 281 clinical trials 281, 283

Experimental arthritis, neutrophil emigration 53, 55

Expert paradigm 459--60 Expiratory resistance 259 ExtraceIlular matrix

component degradation metaIloproteinases 142 proteinase 154

effector role 221-2 fibrosis control 216--22 inflammation control 216--22 lung repair 481 remodeling by fibroblasts 205 structure 205, 207

Extracorporeal CO2 removal (ECCo2R) 427

blood flOW reduction 427 bypass time 433 cardiac output 428 coagulation disorders 428 low frequency positive pressure

ventilation 427, 429, 451 prepulmonary oxygenation of

blood 428 survival rate 428, 433--4 systemic heparinization 428 venovenous vascular access 427-8

Extracorporeal gas exchange 425-8, 439

Extracorporeal membrane oxygenation (ECMO) 425

additional oxygen transfer 429-30 adjunctive strategies 324 anticoagulation 431-2 arterial cannulation 429 blood replacement 431-2 bypass time 426, 433 centrifugal pumps 431 clinical trial 457 CO2 removal427-8 development 425--6 equipment development 434 fast entry criteria 432, 433 fiberoptic bronchoscopy 432 heparin coated systems 428 inclusion criteria 432-3 last resort therapy 434 lung rest 426 maximum assist 429 membrane oxygenators 429, 430,

431,432 mortality 434 neonatal 428, 498-9

respiratory failure 427 optimal PEEP 432

persistent pulmonary hypertension of the newborn 498-9

reservoir 428-9, 431 roller pumps 429, 430 slow entry criteria 432, 433 surface heparinized equipment

431 survival rate 433--4 US study 426-7 venoarterial access 428 venoarterial bypass 426 venous return route 429 venovenous bypass 428 ventilator regimen 432

Extrapulmonary gas exchange 439

Factor V 175 Factor VIIa 516 Fat emboli in lungs 9 Fenton reaction 173, 174

superoxide driven 187 Ferric-ethylene diaminetetra-acetic

acid 170 Ferritin 174, 175 Ferroxidase 168, 183

activity 175 antioxidant activity 185

Ferryl ion 174 Ferryl species 181 Fetal lung imrnaturity 269

alveolar flooding 270 Fibreoptic bronchoscopy 432 Fibrin

dot breakdown 56 degradation products 270 deposition in ARDS 155

Fibrinogen 274 degradation products 203

Fibroblast 29 abnormal proliferation 482 activity 367 apoptotic neutrophil recognition

61 controlled replication 481 ECM remodeling 205 granulation tissue 225 1L-8 source 218 MCP-l production 218 metalloproteinase expression 150 migration 215-16

into alveolar exudates 43 M1P-a production 218 PDGF action 219 phagocytosis of senescent

neutrophils 61 proliferation 43

in alveolar damage 205 proliferative response 223--4

maladaptive 215--16 TGFß exposure 225

Fibroblast derived growth factor 221

Fibroblast growth factor 223 Fibroblast pneumocyte factor 284 Fibronectin 147, 216, 222

depletion 242 deposition 155 removal from alveolar spaces 156 stromelysin degradation 141-2

Fibrosis cellular interactions 222-5 colony stimulating factor effects

220 radiography 368 reaction 215 TGFß role 220 TNFa association 218

Fibrotic process end stage 43 FI02 393, 489 Fluid

balance 481-2 negative 486, 489

management strategies 487-8, 489 restriction for dry lung

maintenance 338 therapy 338-9

Formyl methionyl leucine phenylalanine 73

Formyl-met-Ieu-phe (FMLP) 103 receptor 106

Free radical 170 copper as catalyst 174--5 formation 172-6

Fucosyltransferase 117-18 Functional residual capacity of

lungs 254 lung function improvement 254--5 normal value 254

Functional state, outcome 469

Gas distribution and ventilatory

frequency 411 passive expiration 410 Taylor dispersion of molecules

411 Gas exchange 255-6

dead space 255 impairment 255 intravascular 439, 445 peripheral 331

Gastric alkalinization 238 Gastric intramucosal pH 340 Gastrointestinal tract

bacterial translocation 324 selective decontamination 326

Gelatinase 142, 146

Index 531

Gelatinase B macrophage secretion 149 monocyte excretion 148

General scoring systems 384--5 Glasgow coma scale 382 Glucocorticoids 511 Glucose oxidase 190 Glucosy1ceramide 203 Glutathione 75, 200

peroxidase 174, 179, 180, 185 reduced 187 superoxide radical reaction 187

Glycocalyx layer of respiratory epithelial cells 239

Glycosaminoglycans 221-2 Gram-negative bacteria

aerobic 237 antibiotic promotion 238 oropharyngeal dearance 233 secondary infections 236-7 type specific antibody delivery

353,354 Granulation tissue components 225 Granulocyte colony stimulating

factor (G-CSF) 219 Granulocyte-macrophage colony

stimulating factor (GM-CSF) 40-1, 62, 219, 220

inflamrnation role 220 priming 105 scarring mechanism 224, 226

Granulocytes apoptosis 59

in ageing 59-60 clearance 59, 61-2 inflammation control 63--4 regulation by external

mediators 62-3 dearance

of apoptotic 59, 61-2 of extravasated 57

emigration cessation 52-3, 54, 55 Guanosine monophosphate, cydic

497 Guanylate cydase, soluble 497

HA-lA therapy 512 Haber-Weiss reaction 187 Hawthorne effect 463 Heart size, pulmonary edema 370 Heat shock proteins 516 Hematocrit, optimal 337 Heme compounds 180 Heme proteins 175 Hemodynamic status stability 338 Hemofiltration, continuous

arteriovenous 487, 488 Hemoglobin 175, 180

NO reaction 496

532 Index

Hemorrhagic shock 332 microbial clearance 243 neutrophil sequestration 40

Hemosiderin 175 Heparan sulfate 222 Hepatocyte growth factor 205 Heroin, pulmonary edema 5 High frequency jet ventilation

(HFJV) 410 airway pressure fluctuations 416,

417 carbon dioxide clearance 417 combined technique 419 improved equipment 416--17 mean airway pressure 417 multicenter trial 416--18 NO delivery 420 pediatrics 418 survival rate 418 technology 412-13

High frequency oscillation (HFO) 410,419-20

High frequency positive pressure ventilation (HFPPV) 409-10

High frequency ventilation (HFV) 409

barotrauma 414-15 clinical application 409 clinical trials 416--18 CO2 elimination 411, 412 combined 418--19 gas exchange 410-12 gas mixing 411 HFO 410, 419-20 humidification 413 improved equipment 416--17 inspiratory time 412 jet ventilator

developments 414 improved capacity 413 technology 412-13,414 valve response times 414 visual output 413

mean airway pressure 415 NO delivery 420 oxygenation 412 pendelluft 411 pressure burden on patient 415 surfactant delivery 420-1 technology development 409,

420-1 volume recruitment maneuvers

415 Holistic research 461 Hollow fiber membrane oxygenator

technology 440 Hospitalization, length of stay 15 Host defense 233-5, 508, 510

colonization 237-8

HRCT, see Computed tomography (CD, high resolution

Human elastase inhibitors 146, 150, 153, 156

Human leukocyte elastase (HLE) 141, 145

activity against elastin 141 alveolar-capillary barrier damage

153, 154 common pathway for lung tissue

injury 156 concentration in azurophil

granule 152 elastin binding 153 endothelial cell detachment 153-4 expression on PMNs 152 inhibitors 146, 150, 153, 156 levels in ARDS patients 155 matrix proteins attacked 141 in monocytes 148 PMNs 147 release by mononuclear

phagocytes 149 Human macrophage elastase 143,

145,146 macrophage secretion 149

Human sepsis syndrome 512 Humidification in high frequency

ventilation (HFV) 413 Humoral factors, sepsis

pathogenesis 508 Humoral immune response 235 Hyaline membrane 5, 38, 39

alveolar wall incorporation 43 DAD repair stage 42 formation 215 surfactant deficient lung 415

Hyaline microthrombus 38, 40 Hydrochloric acid installation 278,

281 Hydrogen peroxidase 167 Hydrogen peroxide 75, 167, 168,

169, 170, 174 air spaces of ARDS patients 241 DNA damage 190 plasma antioxidant 185

Hydroperoxyl radical 171 5-Hydroxyeicosotetranoic acid 106 Hydroxyl radical 169, 171

seavengers 173 4-Hydroxynonenal 189 Hypereapnia, aeeeptanee 401 Hypereapnia, permissive 258, 325,

399-400 lung injury 399 metabolie acidosis 400, 402 pharrnaeologieal buffering 401 sedation 400 survival effects 399

Hypercarbia 495 Hyperlactatemia, septic shoek 340 Hyperoxia 169

IL-8 production 92 infeetion risk 243 model 277, 280 mueoeiliary clearance 243 surfactant metabolism in injury

203 Hyperoxide radical 170 Hypocarbia 412 Hypoehlorous acid 167, 168--9 Hypotension, renal failure 487 Hypothesis generation 464 Hypothesis testing 464, 469

errors 464-5 Hypoxemia 5

eauses 255 intrapulmonary shunting 304 severe refractory 495

Hypoxia 8 ehronic in ARDS 305 mierobial clearance 243 see also Pulmonary

vasoeonstriction, hypox.ie

Ibuprofen 515 ICAM-l, acute lung injury 207 Idiopathic pulmonary fibrosis 90,

91, 219 IL-l production 217

Imaging ehest radiography 361-71 computed tomography (CT)

371-3,374 magnetie resonanee imaging

(MRI) 374-5 positron emission tomography

(PET) 375 Immunoglobulin 116 Immunoglobulin A 234

elastase cleavage 241 Immunoglobulin G, elastase

cleavage 242 Immunoglobulin superfamily 126--8

earcinoembryonie antigen (CEA) 126--7

Immunomodulatory agents 508 Indomethaein 515 Infantile respiratory distress

syndrome 37, 263 artificial surfactants 276, 277 high frequency oseillation 419 phospholipids 269, 270 prophylactie therapy 284 surfaetant deficiency 269, 275 therapeutic surfactant use 276,

277

Infection ARDS complications 233 inflammatory response 326 site and mortality 384 see also Sepsis

Inflammation beneficialSO, 51 cellular interactions 222-5 chronic 50, 65 clearance phase 56-64

debris clearance 56-7 extravasated granulocytes 57 fluid clearance 56-7 protein clearance 56-7

event sequence 64-5 granulocytes 63-4 initiators 508 intravascular 14 mediators 507, 513

blocking 507 dissipation 51-2 immune therapy targets 508 targeting 508

monocyte maturation 65 neutrophil influx 65 progression 49-51 propagation 222 resolution 49-51 tissue injury response 222

Inflammatory cascade, cytokines 512

Inflammatory cells 507 colony stimulating factor effects

220 extracellular substrate

degradation 151 injurious molecules 104 injurious potential regulation

104-5 interaction with extracellular

matrix 150-1 secretion control 56

Inflammatory mediators 10, 16, 18, 26

glucocorticoid effects 511 Inflammatory process 508 Inflammatory response, self-limited

50 Injury severity score 383 Inotropic drugs 489 Inspiratory time (I-time) 412 Insulin-like growth factor (IGF) 221

inflammation 216 mesenchymal cell proliferative

capacity 223 ß2-Integrin 121, 123

bin ding to endothelium 124 Integrin-mediated process control

125

Integrins 53, 55, 61, 116, 122-6 cytoskeletal protein links 125 function regulation 125-6 inserted (I) domain 123 leukocyte adhesion deficiency 123 ligand binding 123 receptors 122 see also Leukocyte integrins

Intensive care unit care costs 451 control466 ethics of trials 467 improved therapy 484 individualized patient care 458 length of stay 15 NO delivery 501-2, 503, 504

Intention 457 Intercellular adhesion

processes 115 regulation 128

Intercellular adhesion molecule 1 (ICAM-I) 41, 52, 101, 124, 125

neutrophil migration 102 Intercellular adhesion molecules

(lCAMs) 127 LFA-1 ligands 124-5

Interferon gamma 512 Interleukin 1 (lL-1) 512

acute inflammatory response 216, 217

alveolar macrophage release 199 E-selectin expression induction

120 early response cytokine 94 endothelial adhesive molecule

upregulation 55 Exosurf inhibition 286 hyperoxic lung injury protection

200 inhibition 511 LPS stimulation of macrophage

release 76 media tor of vasconstrictor

hyporesponsiveness 306 pulmonary inflammation 86-7, 90 scarring mediation 222, 223

Interleukin 1 receptor antagonist (IRAP) 86, 87

Interleukin 6 (IL-6) 286, 512 Interleukin 8 (IL-8) 16-17,25,41,51,

512 activity 88 acute inflammatory response 216,

218 at risk patients 92 expression 88

amplification 92

Index 533

by alveolar-capillary membrane 92

LPS stimulation of release 76 neutrophil

chemotactic effects 52 exposure 53 recruitment 92

priming 105 pulmonary inflammation 86, 87-8,

90 Interleukin

neutrophil priming 73 receptor agonist 326

International Classification of Diseases ICD-9 14

Interstitial cell abnormal proliferation 481, 482

Interventional studies 463-5 Intestinal permeability, trauma 78 Intra-alveolar connective tissue

matrix deposition 205 Intra-alveolar hemorrhage 5 Intracellular alkalinization 103 Intrapulmonary shunt 258

inhaled NO 500, 501 Intravascular gas exchange 439

technology 445 Intravenacaval gas exchange

supplementation 402 Intravenacaval oxygenation (IVOX)

381 alveolar overdistension risk 445 blood

flow patterns 440 oxygen carrying capacity 446 studies 444

clinical application 441 clinical benefits 443 clinical experience 446-7 clinical trials 442-4 CO2 clearance 444, 446-7 complications 444 design 440-1 device 440 gas transfer 440, 443, 445-6, 447 long term implants 441 lung injury score 386 membrane surface area

limitations 442 net oxygenation benefits 446 oxygen transfer gradients 446 oxygenation transfer capacity 445,

446 pathological findings 443 patient groups 447 patient management 442, 443 performance 441 physiological difficulties 445-6 pressure control ventilation 447

534 Index

Intravenacaval oxygenation (IVOX) (contd.)

risk/benefit ratio 444 safety 447 size of deviee 444 structure 440-1 survival 442 ventilation-induced damage 447 ventilatory intensity 445

Intravenous membrane oxygenator (IMO) deviee 445

Iron 168 bleomycin detectable 177-8 complex 170 dietary intake 175 distribution in body 175 intestinal absorption 176 ion binding 174 nontransferrin bound 177 overload 176 oxidization 172, 173 oxygen interaction 173 plasma levels in ARDS 177 storage proteins 176 transferrin binding 180-1 transport proteins 176

Ischemia-reperfusion 323 ITPV; see Ventilation, intra tracheal

pulmonary

K+ voltage gated channels 302 Keratinocyte growth factor 205 6-Keto prostagIandin F1a 75 Klebsiella pneumoniae, hypoxia effects

on clearance 243

L-selectin 53, 116, 118 expression 120-1 glycoprotein recognition 119 structure 118

Lactate, blood levels 339-40 cellular hypoxia marker 336 D02 reduction 339 pathological Vo2/Do2

dependency 333, 335, 340 Lactic acidosis 487 Lactoferrin 155, 174, 175

conducting airways 234 nasopharyngeal secretions 233

Lactoperoxidase, nasopharyngeal secretions 233

Lamellar bodies 197, 268 Laminin, stromelysin degradation

142 Langmuir-Wilhelmy balance 265 Latent period 25 Leaky capillaries 481 Least inspired oxygen fraction (FIo2)

393

oxidative lung injury 489 Legionella spp. 240 Leukocyte

activation 40 CEA related antigen expression

126 emigration mechanisms 128 glycoprotein deficiency 102 monoclonal antibodies 513-14 serine proteinases 140-1 see also Polymorphonuclear

leukocyte Leukocyte adhesion

CD43 ligation 128 deficiency 123-4

Leukocyte adhesion deficiency 1 (LADl) 123

bacterial pneumonia 128 Leukocyte adhesion deficiency 2

(LAD2) 117, 118 Leukocyte integrins 53

carbohydrate sulfation/ sialylation 124

function control 124 ligands 124-5

interaction 126 receptor function regulation 125 response 123 subunits 124

structure 121, 123 switching on/off 125

Leukocytoclastic vasculitis 64 Leukosialin, see CD43 Leukotriene B4 52 Leukotriene D 4 300 Leukotrienes

antagonists 303 lung damage 451 role in pulmonary hypertension

303 sulfidopeptide 300, 303

Level of inquiry biochemieal 462 definition 461 dimension/shape resolution 461 matching investigative laboratory

to 461-2 Lewis carbohydrate antigens 118,

119, 124 LFA-1

ligands 124-5 adhesive 127

LFPPV-ECC02R clinieal trial 452 computerized protocol 467 control groups 467 control survival 461 power to detect group differences

465

see also Low frequency positive pressure ventilation

Linoleie acid 187 Lipid

changes in ARDS 187-9 mediators 104 partieIes 181

Lipid peroxidation 178 acceleration 180 products 188

surfactant dysfunction 271 Lipid peroxide plasma levels 188 Lipophilie radieals 180 Lipopolysaccharide (LPS) 41, 72

actin assembly induction 74 alveolar macrophage production

of cytokines 235 alveolar space 76-7 bin ding protein 73 cytokine expression 167 E-selectin expression induction

120 eicosanoid release 75 endothelial cell effects 74 endothelium 76 endotoxic 62 macrophage stimulation 92 monocytes 76 platelet activating factor release

75 priming 105 TNF level effects 242 tolerance induction 77 toxie effects 512 toxie media tor release from

neutrophils 74 Lipoproteins 181 5-Lipoxygenase 303 Liver disease, chronic 18 Low density lipoproteins 181 Low frequency positive pressure

ventilation with extracorporeal CO2 removal 427, 429, 451

Lower respiratory tract, microbe clearance 235

LTB4 106 Lung

alveolar surface area 86 architecture

proteinase injury 153-4 resolution phase of ARDS 156

capacitance and gas distribution 411

collagen deposition 368 collapse 41 compliance 258

static 372-3

consolidation c1earance 367-8 patient positioning 373, 374

cystic air spaces 368 damage

additive effects of factors 396 cytokines 451 leukotrienes 451 polymorphonuc1eocytes 451 subc1inical 25 tumor necrosis factor 451 ventilation 395--60

distribution of shadowing 365 end expiratory volume

maintenance 397-9 epithelial lining fluid

iron bin ding antioxidant activity 185

iron oxidizing antioxidant activity 185

scavenging antioxidant protection 186

extravascular water measurement 375

fat emboli 9 fibrosis 373, 374 hemorrhagic edema fluid 37 inflammatory diseases 49 inflammatory response initiation

86 injury, recovery 49 interstitial pressure lowering 485 interstitial water accumulation

415 linear opacities 368, 369 lymphatics 483 maintenance of dry 338 multiple organ dysfunction

syndrome 318 opacification

ground glass 363, 364, 372, 373 parenchymal 372 with PEEP 366

patchy injury 199 peribronchovascular thickening

363 pressure-volume curves in ARDS

272 primary infection 415 rapid inflation 395 regional overdistension 396 remodeling 205, 206, 207 repair 41-3, 205, 206, 207, 481 rest 426, 427 route of insult 37 shadowing progression 366 shrinkage 43 shunt fraction 372, 373 stiffness 395

surfactant deficiency 41 transalveolar pressure 395 ventilator induced damage 394-7 vital capa city 254 volume 254-5 water distribution 374, 375 weight estimation 372-3

Lung injury 26 acute inciting event 15 ARDS 167 attenuated pulmonary vascular

reactivity 304-5 c1inical presentation 25 complement activation 69-70 fibrosis progression risk 482 IL-1 216 interstitial edema 198 mortality 17 Na +, K+ -ATPase upregulation

484 oleic acid induced 280-1 oxygen free radicals 199-200 parenchymal 6, 8, 13 proteinase inhibition 156 pulmonary vascular control 302-7 response 198 score 7, 8, 258, 385, 386 severity 6, 7-8 spectrum 26 surfactant

composition 29 replacement therapy 204 system 263

see also Acute lung injury Lung water

c1inical studies 253-4 digital radiography 253 distribution by PEEP 485 extravascular 253-4, 481 measurement techniques 253 redistribution with PEEP 399 soluble gas technique 253 thermal dye technique 253

Lycopene 181 Lymphocyte elicitation 90 Lysinuric protein intolerance 201 Lysophosphatidylcholine 203, 204,

266 Lysozyme 155

nasopharyngeal secretions 233

<x2-Macroglobulin 151-2 Macrophage 10, 148-9

activation 323 alveolar 91, 168

fibronectin depletion 242 IL-l release 199 IL-8 source 92 immune defense of lungs 285

Index 535

impairment function in sepsis 242-3

LPS effects 76 micro-organism c1earance 234 opsonin depletion 242

apoptotic neutrophils 60 c1earance 65 destruction 59 phagocytosis 57, 60 recognition 60-1

fate in inflammation 64-5 fluid c1earance 56-7 phagocytic potential 56 proinflammatory response 60 proteinase cell surface receptors

148 urokinase-type plasminogen

activator expression 149 Macrophage colony stimulating

factor (M-CSF) 219, 220 Macrophage inflammatory proteins

(MIP) 218-19 Magnetic resonance imaging (MRI)

374-5 sensitivity for lung water 374

Manganese superoxide dismutase 16, 75, 198

Mannose 239, 240 MAP ERK kinase (MEK) 107-8 MAP kinase 106

activation 107 pathways 107-8

Mast cells 234 serine proteinases 149

Matrilysin 142, 143, 145, 146 Mean CT number 371 Measurement 462, 463 Mediator

dissipation 51-2 efficacy 51

Megakaryocytes 39 Membrane antioxidants 180 Membrane attack complex 70 Membrane oxygenators 425--6 Memory 462, 463 Mesenchymal cells

phenotype 225 proliferation in repair process

223-4 response 216

Mesothelial cells 150 Metalloproteinases 139, 140, 141-3,

146 amino acid sequences 142 bacterial endotoxin upregulation

149 cell surface bound 153 elastin action 145

536 Index

Metalloproteinases (contd.) expression

by macrophages 149 by mesothelial cells 150

extracellular matrix component degradation 142

gene regulation 142 macrophage secretion 149 matrix 143

proenzymes 142 tissue inhibitors 146

Methemoglobin 496 Methemoglobinemia 500-1 Methionine sulfoxide 189 Microatelectasis prevention 394 Microemboli, leukocyte adhesion 40 Microthrombus formation 26

damaged pulmonary capillaries 215

Microtubule associated protein kinase, see MAP kinase

Microvascular endothelium injury 5, 6

Microvascular permeability restoration 55-6

Military casualties 3 Mixed venous oxygen saturation,

see Svo2

Monocyte actin assembly stimulation 76 apoptosis 64-5 cathepsin G expression 153 chemoattractants 93 chemotaxin 51 elicita tion 93 emigration cessation 52-3, 54, 55 heterogeneity 148 HLE expression 153 human leukocyte elastase uptake

148 maturation into inflammatory

macrophages 65 metalloproteinase secretion 148 P type 148 proteinase 3 expression 153 proteinases 148

Monocyte chemotactic peptide 1 (MCP-l) 52, 86, 93

acute inflammatory response 216, 218-19

Monocyte migration 93 production regulation 89 pulmonary inflammation 88-9, 90

Monokines 512 Mononuclear phagocytes,

proteolytic enzyme expression 147

Mortality causes 18, 19, 383, 387

IL-l levels 86 overall 383 pneumonia 236 prediction 31

APACHE 11 scoring system 381, 382

APACHE III 382 model 382

predictors 17-18,383,384 probability model 11 382 rate 17, 21 scoring 383--4 sepsis syndrome 18 severity of ARDS 18 therapeutic intervention influence

383 TNF levels 86

Motive 457 Mucins 116 Mucociliary clearance

hyperoxia 243 pharmacologic agents 243

Multiple inert gas technique 255 Multiple organ dysfunction 18 Multiple organ dysfunction

syndrome 13, 317-18 ARDS

cases 319-20 management 325 relationship 318

bacterial translocation 324 clinical signs 318, 319, 321 diagnostic laparotomy 321 epidemiology 319-20 gastrointestinal tract 324 host inflammatory reaction 323 infectious model 320-1 inflammatory model 321-3 management 324-6 microcirculation 323 panendothelial injury 323 pathophysiology 320-4 prevention 325 primary 322 prognosis 326 secondary 322 therapeutic intervention 320

Multiple system organ failure 14, 18, 26, 331, 485, 507

bacterial translocation 78 renal failure 487 scoring 382

Multisystem vascular disorder, pulmonary component 26

Multisystem vascular injury, diverse 32

Mycobacterium tuberculosis 240 Myelin, tubular 268, 269, 273

Myeloperoxidase 61, 167, 168 air spaces of ARDS patients 241

Myocardial depression 338 Myofibroblasts 215, 216, 225 Myoglobin 175, 180

Na + transport active 484 alveolar fluid clearance 346-7, 348

Na + /H+ exchange (NHE) 102 antiport 102

activation 103--4 phosphorylation 103

Na + ,K + -ATPase 484 NADPH oxidase activation 105-6 Naso-oropharyngeal surface 233 Nasopharyngeal secretions 233 NCA-160 126 Necrosis 57-9 Neisseria spp. 237 Neonatal respiratory distress

syndrome ECMO 427 HFO 410

Neonatal respiratory failure ECMO 427 see also Infantile respiratory

distress syndrome; Persistent pulmonary hypertension of the newborn

Nervous system, nonadrenergic noncholinergic 297-8

Neuromuscular blockade, compliance 257

Neurons, nitroxergic 497-8 Neutropenia, hemodialysis

associated 69 Neutrophil 27, 28

accumulation in lung 215 activating peptide 1/IL-8 18 activating peptide 2 (NAP-2) 88 activation 40, 41, 90-1 acute lung injury 72 adhesion 89, 101, 115

events 117 adhesion molecules 55 adhesion receptor 116

function 127 adhesive interaction with

endothelial cells 28 alveolar function abnormalities

241 anti-CD18 effect on function 514 apoptosis 56, 57, 58, 59, 60

inhibition by inflammatory media tors 62

inhibitory factor 62 neutrophil necrosis balance 64

ARDS pathogenesis 51

azurophil granules 104 CEA related antigens 126 cell surface attachment 152 chemoattractant stimulation 100 chemotactic factor 91, 92

inactivation 53 chemotaxis 25-6, 88

control52 c1earance mechanism 59-60 complement media ted activation

69 CR3 surface expression 125-6 deformability 28 deformation 100 diameter 74 directed thera pies 513-14 dysfunction in ARDS 241 E-selectin receptor 122 elastase 25, 75, 200, 241

complex 29, 30 expression 108 lavage sampies from ARDS

patients 274 elicitation 90 emigration 55, 100, 115-16

cessation 53 events 117 kineties 53

endothelial interactions 326 endotoxin tolerance in sepsis

syndrome 77 excessive response 285-6 granulocytes

demise 56 inflarnrnation resolution 51

idiopathic pulmonary fibrosis 91 irnrnobilizing factor 52 immunopathology of disease 90 inflarnrnatory response 284 influx into lungs 72

damage to alveolar cells 199 injury mechanisrns

inflammatory cell injurious potential regulation 104-5

injury on a surface 108 priming 105-7

leukocyte adhesion deficiency 123 lipid media tors 104 rnacrophage phagocytosis 57 matrix receptors 127 migration 90-1, 168

regulation 102-4 necrosis 64 negative feedback loop 53 oxygen metabolites 104 p150,95 surface expression 125-6 P-selectin receptor 122 priming 72-3, 105-6

before emigration 105

CA2 + role 107 mechanisms 106 PKC role 106-7

proinflammatory potential 59-60 proteinases 146-7 proteolytie enzyme source 215 pulmonary marginated pool 28 reactive oxygen species release

167 recruitment 91, 92, 115

in acute lung injury 74 1L-8 role 92 integrins 125

retention in lung 100, 101 regulation 99-102

secondary stimulus 73 secretory products 104 selectin-mediated adhesion 120 senescent 57

self 56, 57 septie shock 39 sequestration

in capillary bed 101 in hemorrhagic shock 40

shape change 103 stiffness 100 suppression 285 surface adhesion molecules 53 target surface 28, 29 transcapillary migration 52 transit 100

times 99 volume increase 102, 103

Neutrophil-mediated injury 99 retention in lung 99-102

Nitrie acid synthase 41 Nitric oxide (NO) 26, 41, 75, 172,

496 chemiluminescence analysis 502 clinical applications 498 delivery by HFV 420 electrochemieal sensor analysis

502,504 endogenous 299, 500 endothelium derived 497 inhaled 308, 495-504, 514, 516

ARDS 499-500 arterial oxygenation effects 501 benefits 500-1 delivery 501-2, 503, 504 diffusion in lung 501 intrapulmonary shunt 500, 501 loss in circulation 511 lung injury impact 501 monitoring 502, 503 optimal dose 500 with oxygen therapy 501 pulmonary artery pressure 499,

500

Index 537

pulmonary hypertension 498-9 risks 500-1 systemic effects 501

LPS stimulation of macrophage release 76

nasopharyngeal derivation 500 neuron generated 497-8 oxygen reaction 501 platelet adhesion/ aggregation

inhibition 501 production by iNOS 498 properties 496 pulmonary vascular control

298-9,308 pulmonary vascular resistance

effects 498 pulmonary vasodilation 498 selectivity levels 500 synthesis inhibitors 298

hypoxie pulmonary vasoconstriction 301

synthetic pathway 298 toxicity 496, 500 vascular hypocontractility role

306-7 vasodilation 514

Nitrie oxide synthase 496 constitutive (cNOS) 496, 497, 500 expression in vascular smooth

muscle 306-7 inducible (iNOS) 496, 497, 498,

515 induction

inhibition 511 in vascular smooth muscle 515

inhibitors 514 isoforms 514

Nitrogen dioxide 172,496 toxicity 501

Nitrogen washout technique 254 Nitroprusside 307 N-Nitroso-N-methylurethane 278,

279 Nitrous oxide 172, 496 Noise, signal 453-5 Nonadrenergie noncholinergie

nervous system 297-8 Nonpulmonary organ system

dysfunction, mortality prediction 18

Nonspecific crossreacting antigen (NCA) 121

Nonsteroidal anti-inflammatory agents 515

Normocapnia rnaintenance 399 Nosocomial infection 6, 485

02 ERcrit 332 02 flux test 340

538 Index

Oleic acid 187 Oligosaccharides 239, 240 Opsonin depletion 242 Oral flora, normal 238 Organ system failure score 382

see also Multiple system organ failure

Oropharyngeal secretion, aspiration 240

Oropharyngeal surface colonization 237

Oscillating bubble apparatus of Enhrning 265

Outcome data 20 functional state 469 intermediate 464, 469-70 survival 469 ultimate 464, 468, 469-70 variables 469

Overdose, mortality 384 Oxidants, ARDS pathogenesis 271 Oxidative burst 168 Oxidative damage

cell defenses 178-80 DNA 191 protection

in extracellular fluids 180-2 of membranes 180

oxidative killing 234 oxidative molecular damage

186-90 Oxidative stress 168 Oxone 191 Oxygen

activation by phagocytic cells 168-9

arterial saturation (5a02) 339 cellular utilization defect 487 chemistry 169-70 darnage to living cells 186 demand changes 333-4 extraction (02 ER) 331 free radicals 74-5

acute lung injury 199-200 formation 170

iron interaction 172 metabolites 104 neutrophil chemotactic cytokine

production 92 pulmonary toxin 452 reactive species 167-9, 509, 513 reduction intermediates 170-2 requirements in ARDS 168 singlet 171 solubility 170 therapeutic use 452 tissue injury in lungs 169 toxicity 187

restriction 179 type II cells 200

see also Ventilation Oxygen consumption (V02) 331--41

adrenergic agent effects 336 cardiac output increase 340 challenge 340-1 determination methods 335-6 dobutamine effects 334, 336 flow dependent 324 formulas in determination 335 prostacyclin infusion 333 reverse Fick equation

determination 335-6 see also pathological V02/D02

dependency Oxygen delivery (002) 325, 331--41

cardiac output 339 determination methods 335-6 formulas in determination 335 in pathological V02 /D02

dependency 332-3 preload reduction effects 487 prostacyclin infusion 333 supranormal level maintenance

338 Oxygenation

acute lung injury 319 deterioration with iv vasodilators

511 mechanical ventilation 452 NO inhalation 514

Oxygenators 431, 432 Ozone 169, 171

P5363 P150, 95 surface expression in

neutrophils 125-6 Paco2

elevation 400 intravenous gas exchange

techniques 446 Palmitoleic acid 187 Pancreatitis 15 Pa02

functional measurement 372-3 IVOX implantation 444 reduction in early disease 371 respiratory support 337

Papains 143-4 Paradigm 462, 463 Paraquat poisoning 39 Pathological V02/D02 dependency

332-7 acute circulatory failure 333 blood lactate levels 336 challenges 333--7 experimental studies 336-7 gastric intramucosal pH 340

hyperlactatemia 340 mathematical coupling of data

334-5 oxygen demand changes 333--4 thermodilution technique 334-5 see also V02 /D02 dependency

Patient care intensity 454-5 clinical care-giver response 455 dropouts 466 elimination of variation in care

469 fiduciary relationship with

physician 459, 460 good outcome 460 n enrolled 465 outcome 454-5 paradigm of individualized care

458 risk prediction 508

P-codherin 207 Peak inflation pressure 396 Peak inspiratory pressure,

barotrauma relationship 414 Pediatric risk of mortality (PR15M)

score 383 Pendelluft 411 Pentoxyfylline 513 Pepsin 144 Perferryl iron 173 Perferryl species 181 Peripheral gas exchange 331 Peritonitis, secondary infection 242 Peroxynitrate 75 Peroxynitrite 172, 174, 501 Persistent pulmonary hypertension

of the newborn ECMO 498-9 NO inhalation 498

Pflex point 398 obliteration 401

Phagocyte lectin mechanism 60 secretion 56 semiprofessional 61

Phagocytic cells, oxygen activation 168-9

Phagocytosis frustrated 108 oxidative burst 168

Phagolysosome 234 Pharmacological agents 511-16 Pharmacological intervention

strategies 507-8, 509, 510-11 targets 509

Pharmacotherapy 507 Phlebotomy with plasmapheresis

487 Phorbol myristate acetate 72, 103

Phosphatidylcholine 201, 266 infant respiratory distress

syndrome 269, 270 surfactant level decrease 275

Phosphatidylethanolamine 202, 203, 266

Phosphatidylglycerol 202, 203, 266 infant respiratory distress

syndrome 269, 270 surfactant level decrease 275

Phosphatidylinositol 202, 203, 266 infant respiratory distress syndrome

269,270 Phosphatidylserine 266 Phosphodiesterase inhibitors 513 Phospholipase A2 270

plasma 204 Phospholipase D 107 Phospholipase surfactant function

disruption 271 Phospholipid 202

adsorption inhibition 270 BAL content 202 composition 203 infant respiratory distress

syndrome 269, 270 monolayer film 264, 265 recycling 269, 273 regeneration 273 surfactant 263

Phosphor plate digital radiography 362

Physician belief 459, 460 fiduciary relationship with patient

459,460 Pinocytosis, macrophage fluid

clearance 56 Placebo effect 463 Plasma antioxidants 181

changes in ARDS 182-5 extracellular enzymes 185 iron binding activities 182-3 iron oxidizing activities 183-4 scavengers 184 scavenging activities 184-5

Plasma cells 234 Plasma protein

surfactant synthesis inhibition 203

total measurement 273 Plasminogen, plasmin formation

156 Plasminogen activator 146

fibrin removal 156 inhibitors 153 synthesis 147 tissue-type 146

urokinase-type 146, 156 macrophage expression 149 membrane-bound 153

Platelet activation 26, 41 adhesion inhibition 501 aggregation inhibition 501, 515

Platelet activating factor (PAF) 5I, 74

antagonists 516 ARDS patients 75, 76 competitive inhibition 326 endothelial ceH associated 122 lipid mediator movement

regulation 104 LPS stimulation

macrophage release 76 of release 75

mediator of vasoconstrictor hyporesponsiveness 306

neutrophil priming 73 priming 105 pulmonary hypertension 304 receptor on neutrophil 122

Platelet derived growth factor (PDGF)

inflammation 216, 219 mesenchymal ceH proliferative

capacity 223 mitogenie action 219 release in trauma 222 repair process 223-4 scarring mechanism 223, 224

Pleural effusion incidence 365-9 Pneumococcal pneumonia 55 Pneumocystis carinii pneumonia 279 Pneumocytes

type I 5, 29, 41, 42 type II 29

alveolar 6 epithelial regeneration 41-2 hyperplasia 367, 481-2

Pneumonia ARDS patients 236 gastrie aspiration 15 mortality 31, 236 nosocomial 15, 236, 237 pathogenesis 237 pneumococcal 55 pseudomonas 306 see also Streptococcal pneumonia

Pneumothorax HFJV 418 radiography 367 ventilator induced lung damage

394 Polymorphonuclear ceHs, CEA

related antigen expression 126

Index 539

Polymorphonuclear leukocyte lung damage 451 oxidative burst 451 sequestration 40

Polymorphonuclear neutrophil (PMN)

cathepsin G expression 152 HLE expression 152 impaired recruitment with

coexistent disease 242 plasminogen activator synthesis

147 proteinase 3 expression 152-3 proteinases 139, 146-7 proteolytie activity 147

Positive end expiratory pressure (PEEP) 13

adverse effects 484 atelectasis reversal 399 compliance measurement 257 dead space 255 DTPA clearance 253 expiratory resistance 259 extravascular lung water effects

253 gas exchange effects 485 interstitial pressure effects 485 lung compliance 485 lung opacification 366 lung water distribution 485 mortality influence 383 optimal levels 394 oxygen

delivery 394 exchange rate 398-9

Pflex point 398 protection against alveolar

damage 397 re-expansion of collapsed lung

254 renal function 488, 489 therapy 485 tidal volume 398 total applied 401

Positive pressure ventilation, cystie air spaces 368

Positron emission tomography (PET) 375

Power (1-ß) 465 Precision 463 Predictive value of results 464 Preload reduction 485-7

oxygen delivery / uptake effects 487

treatment pulmonary microvascular

pressures 488 strategies 486-7

Pressor response, hypoxie 305

540 Index

Pressure controlled inverse ratio ventilation (PCIRV) 325, 451

clinical trials 455-6 Pressure-volume curve

lower inflection point 401 passive respiratory system 397-8 static lung 258

Pressure-volume relationships 256-8

Probability 465 Propylgallate 179 Prostacyclin 498, 499, 514, 515, 516

aerosolized 308, 516 pathological Vo2 /Do2

dependency 333 pulmonary vascular control 308 release inhibition 301 V02 effects 340

Prostagiandin 201 mediators of vasconstrictor

hyporesponsiveness 306 pulmonary hypertension 498, 499 see also 6-keto prostagiandin F1a

Prostagiandin EI 307, 515 Prostagiandin E2 76 Prostanoids 515-16 Proteases 74, 75, 104 Protein

accumulation index 30 leakage 200 oxidation 188-91 oxidative damage 189-90 plasma levels 188-89

Protein kinase activation 103 Protein kinase C (PKC) 106 Proteinase 139,514

abnormal activity in ARDS 154-5 active site biochernistry 139-45 alveolar-capillary barrier damage

153 ARDS pathogenesis 153-6 cellular sources 146-53 classification schemes 139-53 compartmentalization 151-2 expression by resident cells 150 inhibitors 150-1

inactivation 152 lysosomal 143 preferred substrates 145~ resolution of ARDS 155-6 serine 146

Proteinase 3 141, 145 expression on PMNs 147, 152-3 in monocytes 148 substrate degradation 141

a 1-Proteinase inhibitor 151-2 epithelial permeability 153

Proteinasel antiproteinase theory of emphysema 64

Proteinuria 487-8 Proteoglycans 221-2

cathepsin degradation 144 Proteolytic enzymes 513 Protocols 467-8

clinical care control 468 computerized 463, 467, 468

ARDS survival469 hospital applications 468-9

differential bias reduction 467 right way of interpretation 468

P-selectin 55, 101, 118 adhesion in leukocyte recruitment

120 expression control 120 neutrophil emigration 128 neutrophil receptor 119 neutrophilliung vascular

endothelium interaction 119 plasma levels 18 structure 118 turnover rate 119-20

Pseudomonas aeruginosa N-acetylglucosarnine ligand 240 adherence to epithelial cells 238 clearance 242

Pseudomonas spp. 236, 237 pneumonia 306

Pulmonary artery catheter 338 Pulmonary artery occlusion

pressure 32, 254 acute lung injury 319 diuretics in reduction 485-6 edema prevention 485 reduction 487 survival rate with reduction

485~

Pulmonary artery pressure inhaled NO 500 respiratory failure 510

Pulmonary capillary leak 482 Pulmonary circulation 100 Pulmonary compliance reduction 32 Pulmonary contusion 4 Pulmonary defense impairment

240-3 acute lung injury 240-2 therapeutic intervention 243

Pulmonary dendritic cells 235 Pulmonary edema 4

accumulation 482-3 limitation 485

active Na + transport 484 cardiogenic 369-70, 483 clearance 483-4

acceleration 484, 485 colloids 486 crystalloid solutions 486

distribution 370

head wounds 4 heart size 370 heroin 5 hydrostatic 369-70 hydrostatic pressure gradient

483-4 reduction 485

increased permeability 369-70 left atrial pressure effects 483 limitation strategies 485 rnicrovasculature ultrastructural

changes 483 noncardiogenic 369-70, 495 oncotic pressure 483 osmotic gradients for clearance

484 permeability 325 protein-rich fluid 348, 350, 351 pulmonary artery occlusion

pressure reduction 485 pulmonary capillary

leak 482 permeability discrirnination 374

pulmonary hypertension 30, 510 severe 8

Pulmonary failure scoring system 386

Pulmonary fibrosis idiopathic 90, 91, 217 MIP-l expression 219

Pulmonary host defense 234 distant infection 242-3

Pulmonary hyperernia 4 Pulmonary hypertension 30, 495

acute lung injury 303-4 ARDS 302-3 cardiac valvular lesions 499 inhaled NO 498-9 NO inhalation 499 NO synthase inhibitors 514 prognostic indicator 495 prostagiandin 498, 499 pulmonary edema 510 thromboxane A2 mediation 303 vasoconstrictor response 304

Pulmonary immune response 235 Pulmonary inflammation

acute 89-92 inflammatory cell influx 90

chronic 92-3 cytokines modulating 86-9

Pulmonary inflammatory response, surfactant composition 285

Pulmonary leak, noncardiogenic 200 Pulmonary mechanics 256-9

pressure-volume relationships 256-8

Pulmonary microcirculation 323

Pulmonary microvascular surgery 415-16

pulmonary opacification 363, 364, 366, 372, 373

Pulrnonary physiology, acute lung injury 251-9

Pulmonary vascular compression, emphysema 367

Pulmonary vascular control endothelial 298-9 endothelins 302 hypoxic pulmonary

vasoconstriction 299-302 local298-9 lung injury 302-7 mechanisms 297 nervous control 297-8 nitric oxide 298-9, 308 normallung 297-302 prostacyclin 308 therapy prospects 307-8 vasodilators 307

Pulmonary vascular dysfunction 510

Pulmonary vascular permeability determination 374, 375

Pulmonary vascular reactivity attenuated 304-5 pseudomonas pneumonia 306

Pulmonary vascular resistance 30 NO inhalation 498 NO synthase inhibitors 514 respiratory failure 510

Pulrnonary vasoconstriction, endothelins 302

Pulmonary vasoconstrietion, hypoxie 30, 255, 299-302, 510

endothelin mediation 301 failure 305 leukotrienes 300-1 mechanisms 299-300 NO synthesis inhibitors 301 normal lung response 304-5 prostacyclin release inhibition 301 pulmonary vascular smooth

muscle contraction 301 Pulmonary vasodilation, NO

inhalation 498 Pulmonary vasodilators 510 Pulmonary vasomotor responses

297

Quality improvement, continuous 469

Radieal formation in cells 178-80 Radiographie abnormalities 362-8

0-24 hours 363-5 2-3 days 365-6

4-7 days 366-8 7 days 368, 369 air space shadowing 365 consolidation clearance 367-8 emphysema 365, 367 fibrosis 368 linear opacities 368, 369 pneumothorax 367

Radiographic score 370-1 mean CI number correlation 371

Radiolysis 171, 173 Raf activation 108 Random error 463 Randomization 466-7

controlled double blind trials 467 Ras-Raf MAP kinase pathway 107 Rb-163 Reactive oxygen species 167-9, 509,

513 Recall 462, 463 Red blood cell radiolabeling 30 Redox potential 170 Reductionist research 461 Regression to the mean 463 Reiter' s cells 57 Relatedness of variables 462 Renal failure

hypotension 487 multiple systems organ failure

487 septic shock 487

Renal function 481-2, 487-8, 489 impaired 487 mechanieal ventilation 488 PEEP 488

Renin 144 activity 488

Rescue therapy 466 clinieal trials 457

Respiratory epithelial cells glycocalyx layer 239 oligosaccharides 240

Respiratory failure, acute 31 Respiratory gases, passive

expiration 410 Respiratory impairment 30

after recovery 19 Respiratory support, extracorporeal

425 Respiratory system, decreased

compliance 5 Retinyl stearate 181 Retrospective studies 455 Risk period 25

Saline lung lavage 277-8 Salvage therapy, HFO 410

Index 541

SAPS 11 382 see also Simplified acute

physiologieal score (SAPS) Sarcoidosis 86 Scarring 65 Scarring mechanisms 215-16

cytokine production 223-4 fibrosis control 216-22 inflammation control 216-22 mediators 222 outcome 222-3 resolution 226 stroma response 223-5

Second messenger 305-6 Secondary infection

coexistent disease 242-3 colonization 237-40 host defense 233-5 organism entry route to lung 240 pathogenesis 236-7 peritonitis 242 pneumonia 236 pulmonary defense impairment

240-3 Selectins 116-22

adhesion mediation 119-20 control 120-2

family 116 fucosylation of ligands 117 ligands 118-19 neutrophil recruitment 117

Senescent self 56, 57 Sepsis 15, 16, 331

ARDS 167 bacterial secretion of

phospholipases 271 cell redox state 487 lung injury 26 microcirculatory injury 323 mortality 384 myocardial depression 338 nonhypotensive and renal failure

487 oxygen extraction capabilities 332 panendothelial damage 507 pathogenesis 508 precipitating condition 31 see also Infection

Sepsis syndrome 18 ARDS complications 233 lung injury 236

Septic shock 18 alveolar fluid clearance 352 bacterial products 41 hyperlactatemia 340 IL-l overexpression 87 neutrophils 39 renal failure 487 TNF effects 86-7

542 Index

Serine proteinases 139, 140-1, 146 amino acid residues 140 basophils 149 macrophages 148 mast cells 149 precursors 140-1

Severity scoring 381-7 APACHE 381-2 general scoring systems 384-5 ideal system 386--7 injury severity score 383 mortality 383--4

prediction model 382 probability model II 382

organ system failure score 382 PRISM 383 proposed system 387 specific 385~ TRISS method 383

Shear stress, luminal 497 Shock 3, 323--4

leukocyte activation 40 megakaryocyte numbers 39 multisystem endothelial damage

41 neutrophil activation 41 platelet activation 41 pulmonary complications 9

Shock lung 4, 9 capillary congestion 41 pathology 38

Sialic acid 239-40 Siderophores 172 Signal-to-noise ratio of clinical

problem 453-5 causal inferences 463 decision making 458 likelihood of doing good 458 ultimate clinical outcomes 468

Silo fillers' disease 496 Simplified acute physiological score

(SAPS) 381, 385 Smooth muscle cells, granulation

tissue 225 Sp-A201, 204, 268, 269

alveolar epithelial type II cells damagel dysfunction 273

host defense role 273 protease damage 271

Sp-B 268, 269 Sp-C 268, 269 Sp-D 268, 269 Sphingomyelin 202, 203, 266

infant respiratory distress syndrome 269,270

Standard of practice 457 Staphylococcus aureus clearance

240-1, 242, 243 Staphylococcus spp. 237

Starling equation 325, 483, 485 Starling relationship 251, 254 Stilbene disulfonates 202 Streptococcal invasion of lung,

pulmonary inflammatory response 50

Streptococcal pneumonia 50, 51 macrophage 59 neutrophil apoptosis 64 neutrophil migration 53, 54 resolution 51

Streptococcus pneumoniae clearance 241 infection model 279

Streptococcus spp. 237 Stromelysin 142, 143, 146

macrophage secretion 149 tryptase activation 149-50

Sugar-lectin recognition mechanism 61

Sulfidopeptide leukotrienes 300, 303 Super-positive end expiratory

press ure (PEEP) 399 Superoxide 167, 168

anion 170-1 generation 105

biological toxin 187 NO reaction 174 PKC priming 106 prirning agents 105 production 174

Superoxide dismutase 40, 171, 179 aerobic life 174 catalase 174 enzymes 173, 187 extracellular 180 manganese-containing 185 recombinant human 514

Superoxide theory of oxygen toxicity 186

Supportive therapy 484 adverse effects 484-5

Surface adhesion receptors 116 Surfactant

abnormal metabolism 203 alveolar surface tension

regulation 26~ apoproteins 201, 204, 267-9, 270 artificial 381

multicenter study 386 biochernical composition 266--9 bronchoalveolar lavage 266 bubble model 264-5 C-reactive protein effects 274 cigarette smokers 266--7 compartrnentalization 204 composition 263--4

altered 203, 271-5 in ARDS 272

changes 285 phospholipid 266, 272, 273,

274-5 delivery by HFV 420 dispersal 421 dysfunction 263, 264, 271-3

mechanisms 269-71 extracellular killing of microbes

241 film-pressure 264 function 201-4

assessment 272 host defense role 28~ immunosuppressive effects on T

cells 285 inadequate synthesis 202 infant respiratory distress

syndrome 269 lung injury effects 271-5 mechanism for changes in ARDS

273 model

antilung serum 278, 279 bilateral vagotomy 278,279 hydrochloric acid installation

278,281 hyperoxia 278, 280 N-nitroso-N-methylurethane

278,279 oleic acid induced lung injury

280-1 natural extract use 275 phospholipid 202

alterations 274-5 composition 266, 272 stimulation with corticosteroids

284 plasma protein

inhibition 270 leakage 272

pool size 275 protein 200

contarnination 270, 272, 273--4 inhibition of function 274

replacement 510 clinical experience 281-5 nebulization 283--4 prophylactic 283 saline lung lavage 277-8 therapy 204, 263, 275-85

reuptake regulation 201 secretion regulation 202 shallow breathing effects 203 structural alteration 203--4 surface film adsorption 273 surface tension lowering 265, 271 synthesis 269

inhibition 203 regulation 201

system 263 therapeutic 204, 263, 275-85 therapy in infection models 279 turnover 269

Surgery high risk patients 326 pulmonary microvascular 415-16

Survanta 282-3 Survival

outcome 469 prediction 455 pulmonary artery occ1usion

pressure reduction 485---{) Svo2 measurement 339, 340 Systematic error 463 Systemic hypotension, mortality

prediction 18 Systemic inflammatory response

syndrome 14, 318, 319, 322, 507,508

ARDS relationship 319 media tors 324

T cell activation 235 surfactant imrnunosuppressive

effects 285 Talin 125 Tetrodotoxin 297 Thl cells 235 Th2 cells 235 Thapsigargin 107 Therapeutic choice 459 Therapeutic end points 469 Therapeutic intervention

approaches 338-41 pharmacologicaI507-8, 509,

510-11 pulmonary defense impairment

243 scoring system (TISS) 383

Thiobarbituric acid reactivity (TBAR) 188-9

Thiols oxidation susceptibility 185 plasma 184-5 plasma protein 188-89

Thoracic impedance 253 Thrombin, alveolar-capillary barrier

damage 153 Thrombocytopenia, extracorporeal

perfusion 428 Thrombospondin 61 Thromboxane 60

ARDS patients 75 Thromboxane A2 51, 303, 304 Thymocytes

apoptosis 62 intracellular calcium 62

Tidal cyc1es 397 Tidal volume (VT) 258

CO2 elimination 411, 412 high frequency ventilation (HFV)

412 oxygenation 409 pressure excursion correlation 397 regional hyperinflation 439 ventilation 409

Tissue hypoxia 331 role in ARDS 338

Tissue inhibitor of metalloproteinases 148

ot-Tocopherol 185 Tolazoline 499 Tracheal gas insufflation 401-3

adjunct to mechanical ventilation 403-4

catheter flow 403, 404 CO2 retentiori 403, 404 effectiveness in acute lung injury

403-4 phasic 403 ventilatory benefit 403

Tracheitis 418 Transalveolar pressure 396-7

cyc1ing 395 Transepithelial fluid movement 345 Transferrin 174, 175

gallium-68 labeling 375 iron

binding capacity 176 loading 177, 180-1 saturation variation 182

levels in ARDS 176 radiolabeling 30

Transforming growth factor ß (TGFß) 220-1

anti-inflammatory role 221 ECM component deposition 220 granulation tissue formation 221 immunomodulatory role 220-1 inflammation 216, 222, 223 mesenchymal cell phenotypic

differen tia tion 225 mitogenic effect 220 release in trauma 222 scarring mechanism 224 subtypes 220

Transfusion, massive 15 Transition metal 167

ions 172---{) Trauma 15

external high frequency oscillation 420

infectious complications 322 intestinal permeability 78 mortality 31, 384 multiple injuries 3

Index 543

nonthoracic injury 4 PDGF release 222 surfactant composition 272

Treatment strategies 484-7 alternative 464 deleterious effects 488, 489 fluid management 487-8, 489 hydrostatic gradient reduction

485 negative fluid balance 486, 489 PEEP 485 preload reduction 485-7, 486-7 pulmonary edema limitation 485

TRlSS method 383 Tryptase 148-9 Tumor necrosis factor ot (TNFot) 16,

41,43,512 E-selectin expression induction

120 Exosurf inhibition 286 fibrosis association 218

Tumor necrosis factor (TNF) acute inflammatory response 216,

217-18 acute lung injury 72 alveolar epithelial type 11 cells

200 early response cytokine 94 endogenous expression 86-7 endothelial adhesive molecule

upregulation 55 hyperoxic lung injury protection

200 LPS effects 76, 242 lung damage 451 media tor of vasoconstrictor

hyporesponsiveness 306 neutrophil priming 73 priming 105 pulmonary inflammation 86-7, 90 scarring mediation 222, 223

Tyrosine, aromatic hydroxylation 189

Ultrahigh frequency jet ventilation 416-18

Unsaturated fatty acid oxidation products 188-9

Uric acid 181 Urokinase activity 155 Uteroglobin 204

V/C mismatch 255 V/Q mismatch 30 Vagotomy, bilateral 278, 279 Vascular cell adhesion molecule 1

(VCAM-l) 52 Vascular channels, extramural

tensions 396

544 Index

Vascular endothelial-epithelial barrier damage 19-20

Vascular hypocontractility, NO role 306-7

Vascular pedide, superior mediastinal 369-70

Vascular permeability index 375 inflammation 150-1

Vascular tone alteration 30 Vasoactive agent 338-9

release 26 Vasoactive drugs 307 Vasoconstriction, hyperoxia induced

337 Vasoconstrictors 307

hyporesponsiveness mediators 306

Vasodilatation, endothelium dependent 305

Vasodilators 307, 499, 510 intravenous 510-11 nitrate based 510

Venoarterial Pco2 gradient (VAPCo2) 340

Venous gas tension measurement 256

Venovenous extracorporeal CO2

removal (ECCo2R) 427 Ventilation

airway pressure waveform 456 apneic 427 ARDS325-6

continuous flow 403 damage cyde 447 intra tracheal pulmonary 403 inverse ratio 456 lung damage 394-60

pneumothorax 394 lung protective strategy 40-1 mechanical

adverse effects 484 computerized protocols 469 inhaled NO therapy 501 management techniques 452,

453 oxygenation 452 renal function 488 survival 452

pressure control mode 432 cost 439 lung damage 394 targeted approach 393, 399,

400-1 pressure-limited techniques 451 regimen for ECMO 432 strategies 393

alternative 399-40 traditional 393-4

tidal volume 409 tracheal gas insufflation as

adjunct 402, 403-4 transalveolar pressure limit

401 volume cost 439

see also Pressure controlled inverse ratio ventilation (PCIRV)

Ventilator score 386 Ventilator tubing 238 Very high density lipoproteins 181 Very late antigen 4 (VLA-4) 52 Very late antigen 6 (VLA-6) 123 Very low density lipoproteins 181 Vietnam war 4, 9 Visual noise 453, 454 Vitamin C, see Ascorbic acid Vitamin E 75, 179, 181, 514

plasma levels 189 see also (l-Tocopherol

Vo2/Do2 dependency 331-2 see also Pathological Vo2/Do2

dependency Volutrauma 396-7

see also Barotrauma Von Willebrand factor 16, 121

antigen 451

Weibel-Palade bodies 120 Wet lung 4,8 Wiskott-Aldrich syndrome 128

Xanthine dehydrogenase 70, 189 Xanthine oxidase 75, 200

activity 189, 190

Zymogen 140-1, 147