Abstract
Objective
To develop a method for the assessment of colorectal permeability in septic patients.
Design and setting
Observational study in ICUs at two university hospitals.
Participants
Nine patients with septic shock and abdominal focus of infection, 7 with severe sepsis and pulmonary focus and 8 healthy subjects.
Measurements and results
Colorectal permeability was assessed as the initial appearance rate of 99mTc-DTPA in plasma after instillation into the rectal lumen and as the cumulative systemic recovery at 1 h. To calculate the latter, volume of distribution and renal clearance of 99mTc-DTPA was estimated by an i. v. bolus of 51Cr-EDTA. The initial rate of permeability was increased in patients with septic shock and severe sepsis compared with controls [29.0 (3.7–83.3), 20.6 (3.6–65.5) and 6.0 (2.2–9.6) cpm ml−1 min−1, respectively, p < 0.05)] with a positive linear trend (r 2 = 0.27, p = 0.01) and correlated to L-lactate concentrations in the rectal lumen (r 2 = 0.39, p < 0.05). The cumulative permeability was also increased in patients with septic shock and severe sepsis compared with controls [2.07 (0.05–15.7), 0.32 (0.01–1.2) and 0.03 (0.01–0.06)‰, respectively, p < 0.01] and correlated to the initial permeability rate (r 2 = 0.26, p = 0.01).
Conclusions
In septic patients, the systemic recovery of a luminally applied marker of paracellular permeability was increased and related to the luminal concentrations of L-lactate and possibly to disease severity. This suggests that the assessment of colorectal permeability by systemic recovery of 99mTc-DTPA is valid and that metabolic dysfunction of the mucosa contributes to increased permeability of the large bowel in patients with severe sepsis and septic shock.
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Acknowledgements
We thank the staff at the Departments of Clinical Physiology and Intensive Care, Herlev Hospital and Intensive Care, Rigshospitalet, Copenhagen, for excellent assistance. The Danish Medical Research Council (grant no. 22-03-0335) supported the study.
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Jørgensen, V.L., Nielsen, S.L., Espersen, K. et al. Increased colorectal permeability in patients with severe sepsis and septic shock. Intensive Care Med 32, 1790–1796 (2006). https://doi.org/10.1007/s00134-006-0356-6
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DOI: https://doi.org/10.1007/s00134-006-0356-6