[The therapeutic use of streptokinase in the treatment of shock lung (author's transl)].

After protracted haemorrhagic or traumatic shock, the danger of severe respiratory insufficiency is often very imminent. This serious complication is frequently acutely progressive. Even the early use of adaequate artificial respiration cannot always prevent the developement of shock lung. The significance of the different pathogenic factors is still not definitely clear. The main changes that are most imminent during shock are the organisation and carnification of cells and plasma proteins within the lung parenchyma due to increased extravasation. On the basis of pathophysiological considerations however, it seems reasonalbe to interrupt these reactions through early use of monophasic proteo- and fibrinolysis. The indication for and prognosis of a monophasic streptokinase activated fibrinolytic and proteolytic therapy was first examined in 18 patients with a clinically manifest shock lung. In 11 patients the severe initial pulmonary changes could be reversed within 48-60 hours after the beginning of treatment. The normalization of lung function was confirmed clinically and by means of x-ray and blood gas analysis. In 7 patients in which acute renal failure had occurred the progression of pulmonary failure could not be interrupted. The present study demonstrates for the first time the possibilities of fibrinolytic treatment of the shock lung. The risk of haemorrhagic complications especially in the immediate postoperative or post traumatic phase could be limited by a high dose streptokinase therapy. Under these condition the formation of excessive amounts of free plasmin in the circulation was prevented and the so-called endogenous lysis was primarily achieved.