Pulmonary gas exchange during intramedullary fixation of femoral shaft fractures

Mathew J. Weresh, Michael D. Stover, Michael J. Bosse, Kyle Jeray, James F. Kellam, Steven H. Sims, Jeffrey A. Kline

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: This study was undertaken to determine if the alveolar dead space fraction (Vd/Vt) or the alveolar-arterial oxygen gradient (A-a DO2) increased during intramedullary fixation of femoral shaft fractures. Methods: Fifty hemodynamically stable patients with femur fractures were prospectively enrolled. Three serial measurements of Vd/Vt and A-a DO2 were obtained immediately before femoral nailing (Pre), 30 minutes after nailing (+30), and 120 minutes after nailing (+120). Vd/Vt was determined by simultaneously measuring PaCO2 and the steady-state end-tidal CO2 (PetCO2), where Vd/Vt = (1 - PetCO2/PaCO2). Results: Vd/Vt before nailing was 0.09 ± 0.09 (mean ± SD); at +30 and +120, Vd/Vt was 0.10 ± 0.06 and 0.08 ± 0.07, respectively (p > 0.2; paired t test, both time points). A-a DO2 before nailing was 84 ± 85 mm Hg, and it did not change significantly at +30 (89 ± 69 mm Hg; p = 0.51 vs. Pre; paired t-test) or at +120 (51 ± 45 mm Hg). No difference in data was found with analysis by fracture Classification or number of reamer passes. Vd/Vt and A-a DO2, however, were both significantly increased in patients with lung contusion (n = 6) before nailing, but neither measurement increased after nailing. One patient developed fat embolism (Vd/Vt of 0.35 at Pre and 0.31 at +120), and another patient experienced postoperative pulmonary thromboembolism (Vd/Vt increased from 0.06 at Pre to 0.17 at +120). Conclusion: The process of femoral nailing does not cause enough pulmonary embolization to alter pulmonary gas exchange as measured by Vd/Vt and A-a DO2. If Vd/Vt is increased preoperatively, the likelihood of subsequent pulmonary dysfunction secondary to either preoperative lung injury or fat embolism is increased.

Original languageEnglish (US)
Pages (from-to)863-868
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number5
StatePublished - May 1 1999
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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