Skip to main content
SpringerLink
Log in
Book cover

Yearbook of Intensive Care and Emergency Medicine pp 24–38Cite as

Endotoxin Immune Status and Protection Against Multiple Organ Dysfunction Syndrome in the Surgical Patient

  • Conference paper

  • 153 Accesses

Part of the book series: Yearbook of Intensive Care and Emergency Medicine ((YEARBOOK,volume 1996))

Abstract

Sepsis, and its sequelae of shock and multiple organ dysfunction syndrome (MODS), remain the most common causes of death in intensive care units (ICU), being responsible for 400000 deaths annually in the USA [1]. Despite tremendous advances in technology and vast expenditure on antibiotics and immunotherapy, the mortality remains at approximately 50%. A large proportion of patients developing the clinical picture of sepsis have undergone surgical procedures. This insult exposes the patient to both hemodynamic stress and infective and non-infective inflammatory stimuli. The origins of the infective stimuli are a source of great debate; some evidence points towards the gut as a large septic focus that becomes permeable to bacteria and their products when underperfused [2]. However, this phenomenon has not been demonstrated conclusively in humans. MODS, with a 98% mortality for 3 or more organ system failures persisting > 72 h [3], is the final common outcome for many patients, whatever the initiating stimulus. This chapter explores the possibility that susceptibility to uncontrolled inflammatory activation and subsequent development of MODS can be averted by identification of an “at risk” population and prophylactic intervention before the surgical insult.

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

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Luce JM (1993) Introduction of new technology into critical care practice: A history of HA-1A human monoclonal antibody against endotoxin. Crit Care Med 21: 1233–1241

    Article  PubMed  CAS  Google Scholar 

  2. Deitch EA, Berg R (1987) Bacterial translocation from the gut: A mechanism of infection. J Burn Care Rehabil 8: 475–482

    PubMed  CAS  Google Scholar 

  3. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 202: 685–693

    Article  PubMed  CAS  Google Scholar 

  4. Andersen BM, Solberg O (1984) Endotoxin liberation and invasivity of Neisseria men ingitidis. Scand J Infect Dis 16: 247–254

    Article  PubMed  CAS  Google Scholar 

  5. Giroir B (1993) Mediators of septic shock: New approaches for interrupting the inflammatory cascade. Crit Care Med 21: 780–789

    Article  PubMed  CAS  Google Scholar 

  6. Karunaratne DN, Richards JC, Hancock RE (1992) Characterization of lipid A from Pseudomonas aeruginosa a-antigenic B band lipopolysaccharide by 1D and 2D NMR and mass spectral analysis. Arch Biochem Biophys 299: 368–376

    Article  PubMed  CAS  Google Scholar 

  7. Danner RL, Elin RJ, Hosseini JM (1991) Endotoxaemia in human septic shock. Chest 99: 169–175

    Article  PubMed  CAS  Google Scholar 

  8. Gardiner K, Barbul A (1993) Intestinal amino acid absorption during sepsis. JPEN 17: 277–283

    Article  CAS  Google Scholar 

  9. Heyderman RS, Klein NJ, Shennan GI, Levin M (1992) Reduction of the anticoagulant activity of glycosaminoglycans on the surface of the vascular endothelium by endotoxin and neutrophils: Evaluation by an amidolytic assay. Thromb Res 67: 677–685

    Article  PubMed  CAS  Google Scholar 

  10. Morrison DC, Cochrane CG (1974) Direct evidence for Hageman factor (Factor XII) activation by bacteriallipopolysaccharides. J Exp Med 140: 797–802

    Article  PubMed  CAS  Google Scholar 

  11. Bjork J, Hugli TE, Smedegard G (1985) Microvascular effects of anaphylatoxins C3a and C5a. J Immunol 134: 1115–1119

    PubMed  CAS  Google Scholar 

  12. Suffredini AF, Fromm RE, Parker MM, et al (1989) The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med 321: 280–287

    Article  PubMed  CAS  Google Scholar 

  13. Wakabayashi I, Hatake K, Kakishita E, Nagai K (1987) Diminution of contractile response of the aorta from endotoxin-injected rats. Eur J Pharmacol 141: 117–122

    Article  PubMed  CAS  Google Scholar 

  14. Rees DD, Cellek S, Palmer RM, Moncada S (1990) Dexamethasone prevents the induction by endotoxin of a nitric oxide synthase and the associated effects on vascular tone: An insight into endotoxin shock. Biochem Biophys Res Commun 173: 541–547

    Article  PubMed  CAS  Google Scholar 

  15. Michie HR, Manogue KR, Spriggs DR, et al (1988) Detection of circulating tumor necrosis factor after endotoxin administration. N Engl J Med 318: 1481–1486

    Article  PubMed  CAS  Google Scholar 

  16. Balkwill FR, Burke F (1989) The cytokine network. Immunol Today 10: 299–304

    Article  PubMed  CAS  Google Scholar 

  17. Tracey KJ, Beutler B, Lowry SF, et al (1986) Shock and tissue injury induced by recombinant human cachectin. Science 234: 470–474

    Article  PubMed  CAS  Google Scholar 

  18. Hesse DG, Tracey KJ, Fong Y, et al (1988) Cytokine appearance in human endotoxemia and primate bacteremia. Surg Gynecol Obstet 166: 147–153

    PubMed  CAS  Google Scholar 

  19. Greenman RL, Schein RM, Martin MA, et al (1991) A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. JAMA 266: 1097–1102

    Article  PubMed  CAS  Google Scholar 

  20. Ziegler EI, Fisher CJ, Sprung CL, et al (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin: A randomized, double-blind, placebo controlled trial. N Engl J Med 324: 429–436

    Article  PubMed  CAS  Google Scholar 

  21. Fisher CJ, Opal SM, Dhainaut JF, et al (1993) Influence of an anti-tumor necrosis factor monoclonal antibody on cytokine levels in patients with sepsis. Crit Care Med 21: 318–327

    Article  PubMed  Google Scholar 

  22. Opal SM, Cross AS, Kelly NM, et al (1990) Efficacy of a monoclonal antibody directed against tumor necrosis factor in protecting neutropenic rats from lethal infection with Pseudomonas aeruginosa. J Infect Dis 161: 1148–1152

    Article  PubMed  CAS  Google Scholar 

  23. Bahrami S, Redl H, Thurnher M, et al (1989) Effect of PAF-antagonists in endotoxin shock: Ovine and rat experiments. Prog Clin Biol Res 308: 931–936

    PubMed  CAS  Google Scholar 

  24. Wakabayashi G, Gelfand JA, Burke JF, Thompson RC, Dinarello CA (1991) A specific receptor antagonist for interleukin-1 prevents Escherichia coli-induced shock in rabbits. FASEB J 5: 338–343

    PubMed  CAS  Google Scholar 

  25. Cross AS, Opal S (1994) Therapeutic intervention in sepsis with antibody to endotoxin: Is there a future? Endotoxin Res 1: 57–69

    CAS  Google Scholar 

  26. Braude A, Jones JL, Douglas H (1963) The behaviour of Escherichia Coli endotoxin (somatic antigen) during infectious arthritis. J Immunol 90: 297–312

    PubMed  CAS  Google Scholar 

  27. Opal SM, Cross AS, Sadoff JC (1994) Animal models in sepsis: Their value and limitations. Intensive Care Med 20: S115 (Abst)

    Google Scholar 

  28. Bone RC (1993) Gram-negative sepsis: A dilemma of modern medicine. Clin Microbiol Rev 6: 57–68

    PubMed  CAS  Google Scholar 

  29. McCloskey RV, Straube RC, Sanders C, Smith SM, Smith CR (1994) Treatment of septic shock with human monoclonal antibody. Ann Intern Med 121: 1–5

    PubMed  CAS  Google Scholar 

  30. Bone RC, Balk RA, Fein AM, et al (1995) A second large controlled clinical study of E5, a monoclonal antibody to endotoxin: Results of a prospective, multicenter, randomized, controlled trial. Crit Care Med 23: 994–1006

    Article  PubMed  CAS  Google Scholar 

  31. Fiddian-Green RG, Baker S (1987) Predictive value of the stomach wall pH for complications after cardiac operations: Comparison with other monitoring. Crit Care Med 15: 153–156

    Article  PubMed  CAS  Google Scholar 

  32. Mythen MG, Purdy G, Mackie IJ, McNally T, Webb AR, Machin SJ (1993) Postoperative multiple organ dysfunction syndrome associated with gut mucosal hypoperfusion, increased neutrophil degranulation and C1-esterase inhibitor depletion. Brit J Anaesth 71: 858–863

    Article  PubMed  CAS  Google Scholar 

  33. Deitch EA (1990) The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure. Arch Surg 125: 403–404

    PubMed  CAS  Google Scholar 

  34. Fiddian-Green (1990) Gut mucosal ischaemia during cardiac surgery. Semin Thorac Cardiovasc Surg 2: 389–399

    PubMed  CAS  Google Scholar 

  35. Mileski WJ, Winn RK, Harlan JM, Rice CL (1992) Sensitivity to endotoxin in rabbits is increased after hemorrhagic shock. J Appl Physiol 73: 1146–1149

    PubMed  CAS  Google Scholar 

  36. Deitch EA, Berg R, Specian R (1987) Endotoxin promotes the translocation of bacteria from the gut. Arch Surg 122: 185–190

    PubMed  CAS  Google Scholar 

  37. Nelson DP, Samsel RW, Wood LD, Schumacker PT (1988) Pathological supply dependence of systemic and intestinal O2 uptake during endotoxemia. J Appl Physiol 64: 2410–2419

    PubMed  CAS  Google Scholar 

  38. Andersen LW, Baek L, Degn H (1987) Presence of circulating endotoxin during cardiac operations. J Thorac Cardiovasc Surg 93: 115–119

    PubMed  CAS  Google Scholar 

  39. Mythen MG, Webb AR (1995) Peroperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 130: 423–429

    PubMed  CAS  Google Scholar 

  40. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186

    Article  PubMed  CAS  Google Scholar 

  41. Boyd O, Grounds RM, Bennett ED (1993) A randomised clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270: 2699–2707

    Article  PubMed  CAS  Google Scholar 

  42. Singer M, Bennett ED (1991) Non-invasive optimization ofleft ventricular filling using esophageal Doppler. Crit Care Med 19: 1132–1137

    Article  PubMed  CAS  Google Scholar 

  43. Freeman R, Gould FK (1985) Prevention of fever and gram-negative infection after open heart surgery by anti-endotoxin. Thorax 40: 846–848

    Article  PubMed  CAS  Google Scholar 

  44. Gould EK, Harvey JA, Dytrych JK (1989) Antibody to endotoxin is associated with decreased frequency of postoperative infection. Am J Obstet Gynecol 160: 317–319

    PubMed  CAS  Google Scholar 

  45. Baumgartner JD, Glauser MP, McCutchan JA, et al (1985) Prevention of gram-negative shock and death in surgical patients by antibody to endotoxin core glycolipid. Lancet 2: 59–63

    Article  PubMed  CAS  Google Scholar 

  46. Ziegler E, McCutchan JA, Fierer J, et al (1982) Treatment of gram-negative bacteremia and shock with human antiserum to a mutant Escherichia Coli. N Engl J Med 307: 1225–1230

    Article  PubMed  CAS  Google Scholar 

  47. Pilz G, Kreuzer E, Kaab S, Appel R, Werdan K (1994) Early sepsis treatment with immunoglobulins after cardiac surgery in score-identified high risk patients. Chest 105: 76–82

    Article  PubMed  CAS  Google Scholar 

  48. Mythen MG, Barclay GR, Browne DA, Machin SJ, Webb AR (1992) Endogenous antiendotoxin-core-antibodies and post-operative MODS. Intensive Care Med 18: S57 (Abst)

    Article  Google Scholar 

  49. Hamilton-Davies C, Barclay GR, Machin SJ, Webb AR (1995) Relationship between endotoxin immune status and outcome following cardiac valve surgery. Brit J Anaesth 74:S34 (Abst)

    Google Scholar 

  50. Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330: 1717–1722

    Article  PubMed  CAS  Google Scholar 

  51. Deitch EA, Bridges RM (1987) Effect of stress and trauma on bacterial translocation from the gut. J Surg Res 42: 536–542

    Article  PubMed  CAS  Google Scholar 

  52. Subramanian V, McLeod J, Gans H (1968) Effect of extracorporeal circulation on reticuloendothelial function. 1. Experimental evidence for impaired reticuloendothelial function following cardiopulmonary bypass in rats. Surgery 64: 775–784

    PubMed  CAS  Google Scholar 

  53. Roumen RM, Frieling JT, van Tits HW, van der Vliet JA, Goris RJ (1993) Endotoxemia after major vascular operations. J Vasc Surg 18: 853–857

    Article  PubMed  CAS  Google Scholar 

  54. Trown PW (1994) Preclinical studies with recombinant Bactericidal/Permeability Increasing Proteins (rBPI and rBPI23). Intensive Care Med 20: S146 (Abst)

    Google Scholar 

  55. Leturcq DJ, Moriarty AM, Winn RK, et al (1994) Therapeutic strategies to block LPS interaction with its receptor. Intensive Care Med 20: S146 (Abst)

    Google Scholar 

  56. Astiz ME, Rackow EC, Still JG, Howell ST, Cato A, Von Eschen KB (1995) Pretreatment of normal humans with monophosphoryl lipid A induces tolerance to endotoxin: A prospective, double-blind, randomized, controlled trial. Crit Care Med 23: 9–17

    Article  PubMed  CAS  Google Scholar 

  57. DeMaria AJ, Johns MA, Berberich H, McCabe WR (1988) Immunization with rough mutants of Salmonella minnesota: Initial studies in human subjects. J Infect Dis 158: 301–311

    Article  PubMed  Google Scholar 

  58. Scott BB, Barclay GR (1987) Endotoxin-polymyxin complexes in an improved enzymelinked immunosorbent assay for IgG antibodies in blood donor sera to gram-negative endotoxin core glycolipids. Vox Sang 52: 272–280

    Article  PubMed  CAS  Google Scholar 

  59. Cross AS, Sadoff JC, Cryz SJ (1990) Vaccines against Klebsiella and Pseudomonas infections. In: Woodrow GC, Levine MM (eds) New generation vaccines. Marcel Decker, New York, pp 699–713

    Google Scholar 

  60. Hamilton-Davies C (1995) The effect of monovalent typhoid vaccine on endotoxin immune status. Clin Intensive Care 6: 197

    Google Scholar 

Download references

Authors
  1. C. Hamilton-Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. G. Mythen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. R. Webb
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Clinical Director) (Clinical Director)

Rights and permissions

Reprints and permissions

Copyright information

© 1996 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Hamilton-Davies, C., Mythen, M.G., Webb, A.R. (1996). Endotoxin Immune Status and Protection Against Multiple Organ Dysfunction Syndrome in the Surgical Patient. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine. Yearbook of Intensive Care and Emergency Medicine, vol 1996. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80053-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-80053-5_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-60552-2

  • Online ISBN: 978-3-642-80053-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation