ISSN:0253-4886    

DOI:10.1159/000172438

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172439

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172440

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

It has been suggested that gut hypoxia is important in the development of multiple-organ failure, by triggering increased mediator release, and through altered gut mucosal permeability leading to increased bacterial translocation. Studies generally show that the gut is at risk during circulatory failure, as there is often redistribution of blood flow to other more vital organs. Splanchnic blood flow may not fall in all cases of acute circulatory failure, but an imbalance between oxygen demand and the level of oxygen supply can result in regional ischemia. In septic shock this may be exacerbated by an increase in oxygen demand and alterations in oxygen extraction. If the resultant gut hypoxia is indeed related to multiple-organ failure, then by improving, or at least maintaining, splanchnic blood flow we may be able to improve the associated high mortality rates. Many ways of achieving this have been, and are still being, investigated, but at present the only established methods are adequate fluid administration with the use of adrenergic agents. Early enteral nutrition is also important to maintain gut function.

ISSN:0253-4886    

DOI:10.1159/000172441

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Sepsis and multiple-organ failure (MOF) are associated with a prolonged stay and high mortality rate in surgical intensive-care units. In recent years the occurrence of MOF has been linked with previous hypoperfusion of the gut during a variety of critical conditions. In the present study, we focused on the blood flow pattern (rather than the quantity of flow) in the mucosal microcirculation of the gastrointestinal tract during surgery and hemorrhagic shock. In anesthetized pigs subjected to laparotomy and hemorrhage, mucosal blood flow was continuously recorded using multichannel laser Doppler flowmetry (LDF). During normovolemic conditions, flowmotion at a rate of 3-5 cycles per minute occurred in the gastric, jejunal and colonic mucosa in all the animals. The flowmotion disappeared during severe blood loss and during administration of catecholamines. These results suggest that flowmotion, as measured by LDF, is a normal phenomenon in the mucosa of the gastrointestinal tract, but is disrupted during shock. The physiological and clinical significance of these findings awaits further studies.

ISSN:0253-4886    

DOI:10.1159/000172442

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Analyses of intramucosal pH has provided insight into the pathophysiology of splanchnic ischaemia, although it is unclear whether more accurate information is obtained by determining the pH (with the Henderson-Hasselbalch equation) or simply by measuring the intramucosal pCO2. Although in the clinical setting, tonometry results assist in predicting outcome in selected patients, a positive benefit from tonometry-guided therapy has yet to be demonstrated, and remains a future goal.

ISSN:0253-4886    

DOI:10.1159/000172443

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The passage of viable indigenous bacteria and/or constituents of their cell wall, i.e. endotoxins, from the gastrointestinal tract to extraintestinal organs, has been implicated in the pathogenesis of sepsis, the multiple-organ dysfunction syndrome and death. Unfortunately, these conditions are extremely frequent and carry high mortality rates in surgical patients. In terms of morbidity and mortality, we have compelling evidence from laboratory work in experimental animals indicating the importance of bacteria and endotoxin translocation. In humans, however, the clinical significance of translocation is still a point of debate. This paper focuses on perioperative endotoxemia and bacterial translocation in humans.

ISSN:0253-4886    

DOI:10.1159/000172444

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Understanding of the mechanisms for the development of sepsis during acute pancreatitis has increased greatly over the last 5 years. It has become clear that the gut serves as a source of bacteria in a variety of animal models of acute pancreatitis. Bacterial translocation from the intestinal lumen to extraintestinal sites including pancreatic necrosis may occur via the lymphatic, hematogenous or direct transperitoneal route. Increased mucosal permeability, reduced bowel motility, and an impaired host defense have been identified as possible causes for translocation. Standard prophylactic management for the prevention of sepsis in acute pancreatitis includes the use of systemic broad-spectrum antibiotics with optimal penetration into the pancreas, such as imipenem. However, selective gut decontamination clearly reduces the incidence of pancreatic infection in animal models and, probably, in humans, too.

ISSN:0253-4886    

DOI:10.1159/000172445

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The acute respiratory distress syndrome (ARDS) is a frequent, nonsurgical complication after esophageal resection, and requires immediate counter measures. We recently described the time course of ARDS after esophageal resection as being clinically very consistent, with a peak of pulmonary edema on postoperative day 5. In the present study, we investigated the time course of ARDS mediators such as thromboxane B2 (TxB2), prostaglandin E2 (PGE2) and endotoxin in the central venous and arterial blood of patients who had undergone esophagectomy and subsequently developed ARDS. Serum PGE2 levels in control patients were 3.2 ± 5.9 ng/ml, and 10.5 ± 6.3 ng/ml in patients who developed ARDS, with a trend towards higher PGE2 levels in ARDS patients early postoperatively. TxB2 levels ranged between 0.9 and 1.4 ng/ml in ARDS as well as control patients during the intraoperative course and the first 2 postoperative days, with a trend towards higher peripheral TxB2 levels in ARDS patients. This study provides evidence that PGE2 and TxB2 start to increase in parallel with the rise in pulmonary effusions seen on the chest X rays of patients who develop the clinical picture of ARD

ISSN:0253-4886    

DOI:10.1159/000172446

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

It is important to remember that nutritional support is life-saving for the patient who needs prolonged intensive care. This is also the type of patient in whom the hypothesis of bacterial translocation is most plausible. If its administration is possible, enteral nutrition is of course preferable. However, when the enteral route is not available, or the amounts that can be administered are insufficient, parenteral nutrition should be provided. Existing experimental evidence strongly suggests that glutamine should be included in such parenteral nutrition. Clinical documentation is still sparse, but as commercially available glutamine-containing nutritional products for intravenous use are now appearing on the market, more data should soon become available.

ISSN:0253-4886    

DOI:10.1159/000172447

出版商:S. Karger AG    

年代:1996

数据来源: Karger