Pulmonary epithelial permeability is immediately increased after embolisation with oleic acid but not with neutral fat

Abstract

Pulmonary fat embolism occurs frequently after trauma but its functional significance is often unclear. To obtain direct evidence of lung damage caused by fat embolism we have measured changes in permeability of the alveolar-capillary interface. A permeability index was derived from the half time clearance from lung to blood (T 1/2 LB) of (99m)TcDTPA introduced into the lung in a 1 ml bolus. Three groups of rabbits were studied. Baseline T 1/2 LB, did not differ significantly between groups. After intravenous injection of saline placebo in one group and of 300 mg/kg triolein in another group there was no change in permeability index. After intravenous injection of 100 mg/kg oleic acid in the third group there was an immediate change in T 1/2 LB from a monoexponential baseline 280±20 min (SEM) to a multiexponential curve which was resolved into two components, one with a T 1/2 LB of 3.2±0.6 min (SEM) and the other 39.5±7.6 min (SEM). Statistically significant changes in alveolar-arterial PO2 difference, dynamic compliance, chest radiography, and postmortem lung water accompanied the changes in T 1/2 LB in this group. There were no significant changes in these variables in the placebo or triolein group. Histological studies of the lung tissue of these animals using the osmic acid stain for fat showed no fat in the placebo group, extensive fat embolisation which was densely stained in the triolein group and much less densely stained fat in the oleic acid group. Measurement of the permeabiity of the alveolar-capillary interface provides direct evidence of lung damage after oleic acid embolisation. There were no functional changes in animals with extensive embolisation with triolein.