Acute respiratory failure complicating multiple fractures in the absence of fat embolism. A study of pathogenesis and treatment and a preliminary report of catheterization of the right side of the heart.

Eight patients with multiple fractures were all treated for acute respiratory failure. The investigation included catheterization of the right side of the heart, determinations of alveolar-arterial oxygen gradients and studies of serum lipid and coagulation and of water and protein balance. The magnitude of respiratory failure correlated well with the number of fractures, the duration and degree of hypotension, the quantity of fluids and blood administered for resuscitation, the magnitude and duration of positive water balance, and the degree of serum hypoalbuminemia. In three patients, the pulmonary-artery pressures were normal at the onset of respiratory failure. The essential aspects of successful therapy included the early institution of assisted ventilation and the achievement of early negative negative water balance.