Skip to main content
SpringerLink
Log in

Septischer Schock und multiples Organversagen in der chirurgischen Intensivmedizin

Septic shock and multiple organ failure during surgical intensive care. Evaluation of pulmonary and intestinal dysfunction assessment in a porcine model

Ein tierexperimentelles Modell zur Analyse pulmonaler und intestinaler Dysfunktion

  • Published:
Langenbecks Archiv für Chirurgie Aims and scope Submit manuscript

Abstract

The study deals with an animal model for the problems of surgical intensive care patients. Following repeated applications of E. coli endotoxin W0111:134 under standard conditions, specific hemodynamic and biochemical (TNF, TXA2, PGI2, IL-6, PAF) and morphological (endothelium of the lung) alterations were detected. ARDS patterns induced by the sepsis were analyzed by high-frequency measurement of pressure and flow (385 measurements per breathing cycle). The role of the intestine in sepsis was investigated by ion-selective monitoring of surface potassium activity comparing mucosa and serosa. Every injection of endotoxin was followed by a selective increase of the potassium activity revealing relative ischemia induced by the endotoxin. The profile of the potassium levels on the surface correlates both with the cardiac output and with the prostacyclin levels. The continuous narrowing of the difference between mucosa and serosa, potassium during the period of investigation can be regarded as evidence for pathologic change in permeability fostering the septic course.

Zusammenfassung

Beschrieben wird ein tierexperimentelles Sepsismodell, das der Problematik chirurgischer Intensivpatienten entspricht. Nach rezidivierender Applikation von E.-coli-Endotoxin W0111:134 unter standardisierten Bedingungen konnten spezifische hämodynamische, biochemische (TNF, TXA2, PG I2, IL-6, PAF) und morphologische Veränderungen (pulmonales Endothel) nachgewiesen werden. Die sepsisinduzierten ARDS-Veränderungen werden mit einer Hochfrequenzdruck-und-flowmessung mit 385 Meßpunkten fiber einem Atemzyklus analysiert. Die Rolle des Darms in der Sepsis wurde mit ionenselektivem Kaliummonitoring vergleichend auf der Mukosa and Serosa untersucht. Jede Endotoxingabe wurde vom Dünndarm mit selektiven Anstiegen der Kaliumaktivität als Ausdruck einer Endotoxin-induzierten relativen Ischämie beantwortet. Das Profil der Oberflächenkaliumwerte korreliert sowohl mit dem „cardiaco output” als auch mit den Prostazyklinspiegeln. Die während der Versuchsdauer kontinuierlich abnehmende Mukosa-Serosa-Kaliumdifferenz kann als Nachweis einer die Sepsis katalysierenden intestinalen Permeabilitätsstörung interpretiert werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Aarden LA, De Groot ER, Schaap OL, Lansdorp PM (1987) Production of hybridoma growth factor by human monocytes. Eur J Immunol 17:1411–1416

    Google Scholar 

  2. Antonsson JB, Fiddian-Green RGAD (1991) The role of the gut in shock and multiple system organ failure. Eur J Surg 157:3–12

    Google Scholar 

  3. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet II:319–323

    Google Scholar 

  4. Bachofen M, Weibel ER (1974) Basic pattern of tissue repair in human lungs following unspecific injury. Chest 65 [Suppl] 65:14S-19S

    Google Scholar 

  5. Bachofen M, Weibel ER (1977) Alterations in the gas exchange apparatus in adult respiratory insufficiency associated with septicaemia. Am Rev Respir Dis 116:589–615

    Google Scholar 

  6. Baum M, Benzer H, Putensen H, Koller W, Putz G (1989) Biphasic positive airway pressure (BIPAP) — eine neue Form der augmentierenden Beatmung. Anaesthesist 38 (9):452–458

    Google Scholar 

  7. Benzer H, Koller W (1987) Beatmung — wohin geht die Entwicklung? Langenbecks Arch Chir 372:59–63

    Google Scholar 

  8. Brigham KL, Meyrick B (1986) Endotoxin and lung injury. Am Rev Respir Dis 133:913–927

    CAS  PubMed  Google Scholar 

  9. Cannon JG, Tompkins RG, Gelfand JA, Michie HR, Stanford GG, Meer van der JWM, Endres S, Lonnemann G, Corsetti J, Chernow B, Wilmore DW, Wolff SM, Burke JF, Dinarello CA (1990) Circulating Interleukin-1 and tumor necrosis factor in septic shock and experimental endotoxin fever. J Infect Dis 161:79–84

    Google Scholar 

  10. Coalson JJ, Hinshaw LB, Guenter CA, Berrell EL, Greenfield LJ (1975) Pathophysiologic responses of the subhuman primate in experimental septic shock. Lab Invest 32:561–569

    Google Scholar 

  11. Cotran RS (1987) New roles for the endothelium in inflammation and immunity. Am J Pathol 129:407–413

    Google Scholar 

  12. Craig I, Judges D, Gnidec A, Lefcoe M, Paterson N, Finley R, Sibbald W (1987) Pulmonary permeability edema in a large animal model of nonpulmonary sepsis. Am J Pathol 128:241–251

    Google Scholar 

  13. Cunningham AL, Hurley JV (1972) Alpha-naphthyl-thiourea-induced pulmonary oedema in the rat: a topographic and electron microscope study. J Pathol 106:25–35

    CAS  PubMed  Google Scholar 

  14. Danzmann E, Voigt H, Harzendorf E, Bomm M (1989) Anwendung einer Hochfrequenz-Beatmung bei Patienten mit respiratorischer Insuffizienz. Z Erkr Atmungsorgane 172 (3):299–305

    Google Scholar 

  15. Dinarello CA (1988) Biology of Interleukin O. FASEB 2:108–115

    Google Scholar 

  16. Doebber TW, Wu MS, Robbins JC, Choy BM, Chang MN, Shen TY (1985) Platelet-activating factor (PAF) involvement in endotoxin-induced hypotension. Studies with PAF receptor antagonist kadsurenone. Biochem Biophys Res Commun 127:799–808

    Google Scholar 

  17. Fenzlein PG, Abendroth D, Schilling M, Pfab W, Land W (1989) A new bio-chemical multisensorelement for measurement of organ viability. Abstract 4th International Symposium on Organ Procurement and Preservation

  18. Fitzpatrick FA (1978) A radioimmunoassay for thromboxane B2 in the dog. Circ Res 44 (6):748–751

    Google Scholar 

  19. Flohe' L, Giertz H (1988) Endotoxins, arachidonic acid and superoxid formation. In: Urbascheck B (ed) Perspectives on bacterial pathogenesis and host defense. pp 123–131. Chicago Univ Press, Chicago

    Google Scholar 

  20. Fritz H, Jochum M, Daswald KH, Dittmer H, Kortmann H, Neumann S, Lang H (1986) Granulocyte proteinases as mediators of unspecific proteolysis in inflammation. In: Tschesche H (ed) A review in proteinases in inflammation and tumor invasion. de Gruyter, Berlin, pp 1–23

    Google Scholar 

  21. Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino F (1987) Pressure-volume curve of total respiratory system in acute respiratory failure. Am Rev Respir Dis 136:730–736

    Google Scholar 

  22. Gattinoni L, Pesenti A, Bombino M, Baglioni S, Rivolta M, Rossi F, Rossi G, Fumagalli R, Marcolin R, Mascheroni D, Torresin A (1988) Relationships between lung computed tomo graphic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 69:824–832

    Google Scholar 

  23. Haak CE, De Groot ER, Felt-Bersma JR, Nuijens JH, Strack van Schijndel RJM, Erenberg-Belmer AJM, Thijs LG, Aarden LA (1989) Increased plasma levels of Interleukin-6 in sepsis. Blood 74:1704–1710

    Google Scholar 

  24. Hangen DH, Bloom RJ, Stevens JH, O'Hanley P, Ranchod M, Collins J, Raffin TA (1987) Adult respiratory distress syndrome — a live E. coli septic primate model. Am J Pathol 126: 396–400

    Google Scholar 

  25. Haselton PS (1983) Adult respiratory distress syndrome — a review. Histopathology 7:307–332

    Google Scholar 

  26. Haselton PS, Penna P, Torry J (1981) Effect of oxygen on the lungs after blast injury and burns. J Clin Pathol 34:1147–1154

    Google Scholar 

  27. Hauss J, Pichlmayer R (1991) Posttraumatisches akutes Lungenversagen. Behandlung durch drucklimitierte Beatmung und kontinuierlichen Lagewechsel. Dtsch Med Wochenschr 23; 116 (34):1257–1264

    Google Scholar 

  28. Hensby CN, Jogee M, Elder MG (1981) A comparison of the quantitative analysis of 6-oxo-PGF1 in biological fluids by gas chromatography, mass spectrometry, and radioimmunoassay. Biomed Mass Spectrom 8 (3):111–117

    Google Scholar 

  29. Lefer AM (1989) Significance of lipid mediators in shock states. Circ Shock 27:3–12

    Google Scholar 

  30. Lung program, National Heart and Lung Institute (1972) Respiratory diseases: Task forces on problems, research approaches and needs. Washington, D.C.: Government Printing Office, 171 [DHEW pub. no. (NIH) 73–432]

    Google Scholar 

  31. Meyrick B, Johnson JE, Brigham KLAD (1989) Endotoxin-induced pulmonary endothelial injury. Prog Clin Biol Res 308:91–99

    Google Scholar 

  32. Oettinger W, Walte GO, Jensen UM, Beyer A, Peskar A (1983) Endogenous prostaglandin F2 in the hyperdynamic state of severe sepsis in man. Br J Surg 70:237–239

    Google Scholar 

  33. Pearson FC, Dubczak J, Weary M, Bruszer G, Donohue G (1985) Detection of endotoxin in the plasma of patients with gram-negative bacterial sepsis by the limulus amoebocyte lysate assay. J Clin Microbiol 21 (6):865–868

    Google Scholar 

  34. Peitzman AB, Udekwu AO, Ochoa J, Smith SAD (1991) Bacterial translocation in trauma patients. J Trauma 31:1083–1087

    Google Scholar 

  35. Pichlmayr I, Pohl S, Knitsch W, Schultz A (1991) Kann die Beatmung nach dem Prinzip der “Eisernen Lunge” heute eine Zusatz- bzw. Alternativmethode zur konventionellen Beatmungsform darstellen? Anaestesist 40 (1):39–46

    Google Scholar 

  36. Ramsay G, Newman PM, McCartney AC, Ledingham IM (1988) Endotoxemia in multiple organ failure due to sepsis. Prog Clin Biol Res 272:237–246

    Google Scholar 

  37. Reidy MA, Schwartz SM (1983) Endothelial injury and regeneration — IV. Endotoxin: A nondenuding injury to aortic endothelium. Lab Invest 48:25–34

    Google Scholar 

  38. Rinaldo JE, Rogers RM (1982) Adult respiratory distress syndrome. N Eng J Med 306 (15):900–907

    Google Scholar 

  39. Rixen H, Klosterhalfen B, Pennartz G, Teniz A, Schulz M, Kirkpatrick CJ (1990) Injury to endothelial cells and decrease of proliferation during the course of septic shock. Int Care Med 16:34

    Google Scholar 

  40. Schöffel U, Kopp KH, Manner H, Vogel F, Mittermayer C (1982) Human endothelial cell proliferation inhibiting activity in the sera of patients suffering from “shock” or “sepsis”. Eur J Clin Invest 12:165–171

    Google Scholar 

  41. Schwartz SM, Benditt EP (1977) Aortic endothelial cell replication. I. Effects of age and hypertension in the rat. Circ Res 41:248–256

    Google Scholar 

  42. Snedegard G, Lui L, Hugh TE (1989) Endotoxin induced shock in the rat. A role of C5a. Am J Pathol 135:489–497

    CAS  PubMed  Google Scholar 

  43. Stevens JH, Raffin TA (984) Adult respiratory distress syndrome: I. Aetiology and mechanisms. Postgrad Med J 60: 505–513

    Google Scholar 

  44. Stevens JH, Raffin TA (1984) Adult respiratory distress syndrome: II. Management. Postgrad Med J 60:573–576

    Google Scholar 

  45. Strieter RM, Lynch JP, Basha MA, Standiford TJ, Kasahara K, Kunkel SLAD (1990) Host responses in mediating sepsis and adult respiratory distress syndrome. Semin Respir Infect 5:233–247

    Google Scholar 

  46. Templeton CB, Bottoms GD, Fessler JF, Turek JJ, Boon GD (1985) Effects of repeated endotoxin injections on prostanoids, hemodynamics, endothelial cells, and survival in ponies. Circ Shock 16:253–264

    Google Scholar 

  47. Thulig B, Hachenberg T, Wendt M, Wiesmann W, Sulkowski U (1991) Beatmung in Bauchlage beim akuten Lungenversagen. Anaesthesiol Intensivmed Notfallmed 26 (4):196–198

    Google Scholar 

  48. Tomashefski JF, Davies P, Boggis C, Greene R, Zapol WM, Reid LM (1983) The pulmonary vascular lesions of the adult respiratory distress syndrome. Am J Pathol 112:112–126

    Google Scholar 

  49. Tons C, Fenzlein PG, Winkeltau G, Büsser T, Schumpelick V (1991) Ionenselektives on-line Monitoring der Kalium-Aktivität als Parameter für die Dünndarmischämie. Langenbecks Arch Chir 271–275

  50. West RL, Elovitz MJ, Hardaway RM (1966) Blood coagulation factors activity in experimental endotoxemia. Ann Surg 163:567–572

    Google Scholar 

  51. Worthen GS (1987) Lipid mediators, neutrophils, and endothelial injury. Am Rev Respir Dis 136:455–458

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chirurgische Klinik der RWTH Aachen, Aanchen, Germany

    C. Töns, B. Klosterhalfen, U. Klinge & V. Schumpelick

  2. Institut fur Pathologie der RWTH Aachen, Aanchen, Germany

    C. -J. Kirkpatrick & C. Mittermayer

Authors
  1. C. Töns
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Klosterhalfen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Klinge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. -J. Kirkpatrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Mittermayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Schumpelick
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Töns, C., Klosterhalfen, B., Klinge, U. et al. Septischer Schock und multiples Organversagen in der chirurgischen Intensivmedizin. Langenbecks Arch Chir 378, 217–232 (1993). https://doi.org/10.1007/BF00184364

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00184364

Key words

Search

Navigation