The etiologic factor implicated in the development of pulmonary insufficiency following major nonthoracic trauma is

Posttraumatic pulmonary insufficiency in the absence of significant thoracic trauma has been attributed to a wide variety of etiologic agents, including aspiration, simple atelectasis, lung contusion, fat embolism, pneumonia, pneumothorax, pulmonary edema, and pulmonary thromboembolism. In a landmark monograph entitled Respiratory Distress Syndrome of Shock and Trauma, Blaisdell and Lewis identified fat embolism syndrome as the etiologic factor. The mechanism of this condition appears to be pulmonary alveolar injury due to the mobilization of free fatty acids in the blood as an adrenergic response to trauma, rather than pulmonary injury from embolization of fat globules from fractured bones, as was originally thought.