Sepsis and Organ Dysfunction: From Basics to Clinical Approach PDF
Preview Sepsis and Organ Dysfunction: From Basics to Clinical Approach
Sepsis and Organ Dysfunction From Basics to Clinical Approach A Tribute to Roger Bone Springer Milano Berlin Heidelberg New York Barcelona Hong Kong London Paris Singapore Tokyo A.E. Baue G. Berlot A.Gullo J.-L. Vincent (Eds) Sepsis and Organ Dysfunction From Basics to Clinical Approach ORGAN FAILURE ACADEMY Springer A.E. BAUE M.D. Department of Surgery, Saint Louis University, Health Sciences Center, St. Louis -USA G. BERLOT M.D. Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste -Italy A. GULLO M.D. Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste -Italy l-L. VINCENT M.D. Department of Intensive Care, Erasme University Hospital Free University of Brussels -Belgium O.F.A. -ORGAN FAILURE ACADEMY, VIA BATTISTI, 1 -34125 TRIESTE (ITALY) Steering Committee A.E. Baue M.D., Department of Surgery, Saint Louis University Health Sciences Center, St. Louis -USA G. Berlot M.D., Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste -Italy A. Gullo M.D., Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste -Italy L. Silvestri M.D., Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste -Italy G. Sganga M.D., Department of Surgery, and C.N.R. Shock Centre Catholic University of Sacro Cuore, Rome -Italy © Springer-Verlag Italia, Milano 1999 ISBN-l3: 978-88-470-0052-0 e-ISBN-13: 978-88-470-2248-5 DOl: 10.1007/ 978-88-470-2248-5 Library of Congress Cataloging-in-Publication Data: Applied for This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcast ing, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publica tion or parts thereof is only permitted under the provisions of the Italian Copyright Law of September 9, 1965, in its current version and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the Italian Copyright Law. The use of general descriptive names, registered names, trademarks, etc., in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protec tive laws and regulations and therefore free for general use. Product liability: the publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Simona Colombo, Milan SPIN : 10707117 A TRIBUTE TO ROGER BONE Last year, intensive care medicine lost one of its leading proponents, but Roger Bone is not forgotten. Roger was a prominent and highly respected member of the international intensive care community who is remembered by many for his outstanding scientific contributions to intensive care medicine, particularly in the fields of sepsis and acute respiratory failure. Roger was an enthusiast, dedi cated and committed to his chosen specialty and worked with endless enthusi asm and vision to promote and advance intensive care medicine both at home and abroad. As scientist, clinician, teacher, author and editor, Roger always found time to assist and support the work of his colleagues, willing to take time to listen and offer valuable comment and criticism. His opinions were always respected, even if we did not agree with all his scientific arguments, and his ca pability and commitment to intensive care medicine were never questioned. Roger approached his final illness with remarkable fortitude and bravery, accepting the inevitable with courage and characteristically continuing his sci entific and academic activities throughout, showing many that the process of dy ing is just the final part of living. A charismatic and highly valued leader in intensive care medicine has been taken from us, but Roger Bone has left a great legacy as scientist, clinician, au thor, editor, lecturer, and friend - his memory will live on. J.-L. Vincent Table of Contents Introduction A.E. BAUE.................................................................................................................................... 13 BASIC PATHOPHYSIOLOGY MECHANICS Inflammation: How Much Is Too Much and Can It Be Controlled? V. RUMALLA, AND S.F. LOWRy......... ... ......................................................................................... 23 Injury, Inflammation, Sepsis -Is There a Natural, Organized and Sequential Progression of Neuroendocrine, Metabolic and Cytokine Mediator Events Leading to Organ System Failure? A.E. BAUE.................................................................................................................................... 37 Genetic Predisposition to Sepsis and Organ Failure B.A. ZEHNBAUER, B.D. FREEMAN, AND T.G. BUCHMAN .............................................................. 49 Regulation of the Lung Inflammatory Response P.A. WARD, AND A.B. LENTSCH................................................................................................... 55 CLINICAL INTERVENTIONS IN THE FIELD OF SEPSIS WHAT IS WRONG AND WHAT IS RIGHT Shall We Continue to Talk About (or Use) SIRS in the Twenty-first Century? J.-L. VINCENT............................................................................................................................... 65 Prevention and Treatment of Sepsis -Present and Future Problems A.E. BAUE ................ ... ................... ........ ............. ......................................................................... 69 Sepsis and MODS -What Is Wrong and What Is Right A. GULLO, AND G. BERLOT .......................................................................................................... 83 What Is Clinical Relevance? -Well Controlled Experiments in Normal Animals as Compared to Clinical Studies in Diverse Sick Patients A.E. BAUE ...... .............. .............. .................................................................................................. 95 THE MARKERS OF SEPSIS Apoptosis (Programmed Cell Death) and the Resolution of Acute Inflammation A.H. ROUZATI, R. TANEJA, AND lC. MARSHALL .......................................................................... 107 "Untimely Apoptosis" Is the Password T.G. BUCHMAN ............................................................................................................................. 117 VIII Multiple Therapeutic Agents -Will Individual Therapies, Each of Which Improves Patients, When Given Together, Change Mortality? A.E. BAVE ...........................................•........................................................................................ 123 Endotoxaemia in Critical mness: Rapid Detection and Clinical Relevance I.e. MARSHALL, D.M. FOSTER, P.M. WALKER, AND A. ROMASCHIN ........................................... 137 New and Old Markers in Sepsis K. REINHART, AND W. KARZAI ..................................................................................................... 147 From Cytokines through Immune Effector Cells to the Body M.R. PINSKY ................................................................................................................................ 153 Intravenous Immunoglobulins: Are They Helpful? G. PILZ ......................................................................................................................................... 161 CLINICAL ASPECTS OF SPLANCHNIC ISCHAEMIA AND OXYGEN METABOLISM Is Splanchnic Perfusion a Critical Problem in Sepsis? M. POEZE, I.W.M. GREVE, AND G. RAMSAy ................................................................................ 169 Metabolism and O Consumption in Trauma and Sepsis 2 L. BRAZZI, P. PELOSI, AND L. GATTINONI.. ................................................................................... 181 Intragastric pH (ipH) and PaC0 Monitoring in Sepsis 2 D. DE BACKER, I. CRETEUR, AND E. SILVA .................................................................................. 187 Index ........................................................................................................................................... 195 Authors Index BaueA.E. Dept. of Surgery, St. Louis University Health Sciences Centre, St. Louis, Missouri (U.S.A.) Berlot G. Dept. of Anaesthesiology and Intensive Care, Trieste University School of Medicine, Trieste (Italy) Brazzi L. Dept. of Anaesthesia and Intensive Care, Maggiore Hospital -IRCCS, Milan University School of Medicine, Milan (Italy) Buchman T.G. Dept. of Surgery, Anaesthesiology and Medicine, Washington University School of Medicine, St. Louis, Missouri (U.S.A.) Creteur J. Dept. of Intensive Care, Free University of Brussels, Erasme Hospital, Brussels (Belgium) De Backer D. Dept. of Intensive Care, Free University of Brussels, Erasme Hospital, Brussels (Belgium) Freeman B.D. Dept. of Surgery, Anaesthesiology and Medicine, Washington University School of Medicine, St. Louis, Missouri (U.S.A.) Foster D.M. General and Critical Care Surgery, Toronto Hospital, University of Toronto, Toronto, Ontario (Canada) Gattinoni L. Dept. of Anaesthesia and Intensive Care, Maggiore Hospital -IRCCS, Milan University School of Medicine, Milan (Italy) Greve J.W.M. Dept. of Surgery, Maastricht University Hospital, Maastricht (The Netherlands) GulloA. Dept. of Anaesthesiology and Intensive Care, Trieste University School of Medicine, Trieste (Italy) Karzai W. Dept. of Anaesthesiology and Intensive Care, Friedrich Schiller University, Jena (Germany) Lentsch A.B. Dept. of Surgery, University of Louisville, Louisville, Kentucky (U.S.A.) Lowry S.F. Dept. of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey (U.S.A.) Marshall J. C. General and Critical Care Surgery, Toronto Hospital, University of Toronto, Toronto, Ontario (Canada) Pelosi P. Dept. of Anaesthesia and Intensive Care, Maggiore Hospital -IRCCS, Milan University School of Medicine, Milan (Italy) Pilz G. Dept. of Medicine, Grosshadem Hospital, Ludwig-Maximilians University, Miinchen (Gennany) PinskyM.R. Division of Critical Care Medicine, Pittsburgh University, Pittsburgh, Pennsylvania (U.S.A.) Poeze M. Dept. of Surgery, Maastricht University Hospital, Maastricht (The Netherlands) Ramsay G. Dept. of Surgery, Maastricht University Hospital, Maastricht (The Netherlands) Romaschin A. General and Critical Care Surgery, Toronto Hospital, University of Toronto, Toronto, Ontario (Canada) Rouzati A.H. General and Critical Care Surgery, Toronto Hospital, University of Toronto, Toronto, Ontario (Canada) Reinhart K. Dept. of Anaesthesiology and Intensive Care, Friedrich Schiller University, Jena (Gennany) Rumalla V. Dept. of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey (U.S.A.) Silva E. Dept. of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels (Belgium) Taneja R. General and Critical Care Surgery, Toronto Hospital, University of Toronto, Toronto, Ontario (Canada) Vincent J.-L. Dept. of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels (Belgium) Walker P.M. General and Critical Care Surgery, Toronto Hospital, University of Toronto, Toronto, Ontario (Canada) WardP.A. Dept. of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (U.S.A.) Zehnbauer B.A. Dept. of Surgery, Anaesthesiology and Medicine, Washington University School of Medicine, St. Louis, Missouri (U.S.A.) Abbreviations APACHE, acute physiology and chronic MODS, multiple organ dysfunction syn health evaluation drome ARDS, acute respiratory distress syndrome MOF, multiple organ failure AT, antithrombin NFKB, nuclear factor kappa B BPIP, bacterial permeability increasing pro NO, nitric oxide tein 02ER, oxygen extraction CARS, compensatory anti-inflammatory re sponse syndrome PaC02, arterial carbon dioxide pressure Cli' clearance of the Inth component PAF, platelet activating factor CIS, cellular injury score PAS, p-aminosalicylic acid CLP, cecal ligation and puncture PC02, carbon dioxide pressure COPD, chronic obstructive pulmonary dis PDH, pyruvate dehydrogenase ease PgC02, gastric mucosal PC02 DIC, disseminated intravascular coagulation PGEl, prostaglandin D02, oxygen delivery PI02, inspired P02 ECMO, extracorporeal membrane oxygena tion PMN, polymorphonuclear neutrophil ESL-l, E-selectin ligand-I PV02, mixed venous P02 Fi02, % inspired oxygen Q, perfusion HGF, hepatocyte growth factor SAPS, simplified acute physiology score Hsp, heat shock protein SBITS, score-based immunoglobulin therapy of sepsis ICAM-l, intercellular adhesion molecule-I SIRS, systemic inflammatory response syn ICE, interleukin-l ~ converting enzyme drome IL, interleukin SOFA, sepsis-related organ failure assess IL-lra, interleukin-I receptor antagonist ment INH, isonicotinic acid hydrazide sTNF-r, soluble tumor necrosis factor recep tor ipH, intragastric pH TNF, tumor necrosis factor ISS, injury severity score TSF, total splanchnic blood flow IVIG, intravenous immunoglobulin TSH, thyroid stimulating hormone MARS, mixed antagonistic response syn drome VA, ventilation MD, meningococcal disease V02, oxygen consumption
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