Smoke inhalation in burn patients is a serious medical problem around the world. Inhalation injury increases mortality in addition to increasing infections, ventilator-days, and hospital stays. There are also large numbers of patients subjected to smoke inhalation without burns from cooking fires, burning crops and forest fires. The injury results in a fall in arterial oxygenation as a result of airway blockade, increased pulmonary transvascular fluid flux and loss of hypoxic pulmonary vasoconstriction. The changes in cardiopulmonary function are mediated at least in part by reactive oxygen and nitrogen species. Nitric oxide (NO) is generated by both inducible and constitutive isoforms of nitric oxide synthase (NOS). NO combines with superoxide to form reactive nitrogen species such as peroxynitrite. These reactive nitrogen species can be detected by measuring their reaction products such as 3-nitrotyrosine. The latter is elevated in the airway following smoke/burn injury. The control of NO formation involves poly (ADP ribose) polymerase (PARP) and its ability to up-regulate the activity of nuclear transcription factors through ribosylation. Present data also support a major role for the bronchial circulation in the injury since blockade of bronchial blood flow will also minimize the pulmonary injury. The data suggest that cytotoxins or activated cells are formed in the airway and carried to the parenchyma. These materials cause the formation of oedema and a reduction of PaO2.
|Number of pages||4|
|Journal||Pulmonary Pharmacology and Therapeutics|
|State||Published - Apr 2007|
Bibliographical noteFunding Information:
Support: This work was supported by grants from the National Institute of General Medical Sciences GM-60688 and GM-066312 and the Shriners of North America 8854 and 8540. Dr. Traber is the Charles Robert Allen Professor of Anesthesiology.
- Bronchial circulation
- Nitric oxide
- Pulmonary circulation
- Pulmonary oedema
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Biochemistry, medical
- Pharmacology (medical)