58 WAGNER ET AL HEMODYNAMICS OF PULMONARY CONTUSION interested in finding some new suggestions for treating some very difficult patients. I am still puzzled, however, by how you plan to use these data. My impression is that you are planning to make nonreactors reactors, and I guess the question is whether you plan to intervene pharmacologically. I would assume you would get a homogeneous response to the pharmacological agents. If this is true, which I am sure it is, wouldn’t you therefore exacerbate respiratory distress and pulmonary func- tion? DR WAGNER: Well, I am really not sure as to how much clinical value this is going to have. There are no previous data relating Ann Thorac Surg 1991;52:51-8 hemodynamics to size of injury, and I think these findings help us understand pulmonary contusion a little better. If you did have a nonreactor type of patient with a horrendous, progressive shunt fraction, you might try some sort of vasocon- strictor. Or, in a reactor, if the PVRI was too high, you might consider a vasodilator. On the other hand, we did have a patient with 50% air-space filling whose PVRI was extremely elevated and whose heart rate continued to climb. We thought that he was going to die, and in desperation, we resected a completely consolidated and lacerated right lower lobe with an immediate decrease in PVRI, which resulted in rapid clinical improvement. Statement on the Use of Animals in Research The following statement from the American College of Surgeons is also endorsed by The Society of Thoracic Surgeons animals as necessary should be used; that any pain or distress animals may experience should be minimized; and that, wherever feasible, alternatives to the use of live animals should be developed and employed. The American College of Surgeons believes that now and in the foreseeable future it is not possible to completely replace the use of animals and that the study of whole, living organisms is an indispensable element of biomedical research. The American College of Surgeons supports the respon- sible use and humane care and treatment of laboratory animals in research, education, and product safety test- ing. Further, the membership believes that only as many

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58 WAGNER ET AL HEMODYNAMICS OF PULMONARY CONTUSION

interested in finding some new suggestions for treating some very difficult patients. I am still puzzled, however, by how you plan to use these data. My impression is that you are planning to make nonreactors reactors, and I guess the question is whether you plan to intervene pharmacologically. I would assume you would get a homogeneous response to the pharmacological agents. If this is true, which I am sure it is, wouldn’t you therefore exacerbate respiratory distress and pulmonary func- tion?

DR WAGNER: Well, I am really not sure as to how much clinical value this is going to have. There are no previous data relating

Ann Thorac Surg 1991;52:51-8

hemodynamics to size of injury, and I think these findings help us understand pulmonary contusion a little better.

If you did have a nonreactor type of patient with a horrendous, progressive shunt fraction, you might try some sort of vasocon- strictor. Or, in a reactor, if the PVRI was too high, you might consider a vasodilator.

On the other hand, we did have a patient with 50% air-space filling whose PVRI was extremely elevated and whose heart rate continued to climb. We thought that he was going to die, and in desperation, we resected a completely consolidated and lacerated right lower lobe with an immediate decrease in PVRI, which resulted in rapid clinical improvement.

Statement on the Use of Animals in Research

The following statement from the American College of Surgeons is also endorsed by The Society of Thoracic Surgeons

animals as necessary should be used; that any pain or distress animals may experience should be minimized; and that, wherever feasible, alternatives to the use of live animals should be developed and employed.

The American College of Surgeons believes that now and in the foreseeable future it is not possible to completely replace the use of animals and that the study of whole, living organisms is an indispensable element of biomedical research.

The American College of Surgeons supports the respon- sible use and humane care and treatment of laboratory animals in research, education, and product safety test- ing. Further, the membership believes that only as many