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.