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Permeability Changes

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Pathophysiology of Shock, Sepsis, and Organ Failure

Abstract

About 100 years ago, Ernest Starling defined the forces governing the transcapillary fluid and protein movement and postulated the presence of pores in the membranes that cause an osmotic gradient [1]. Based on these findings and considerations much investigative work has now been done on permeability changes due to various insults. However, lung edema remains a major problem clinically, because this extensive research has not resulted in equally major therapeutic advances. In patients identified as at high risk for development of permeability edema, neither early application of differentiated ventilatory treatment (positive end-expiratory pressure, PEEP) nor the administration of corticosteroids could prevent the development of permeability edema [2, 3]. At present it is believed that the cornerstones of therapy are to maintain adequate organ perfusion and to prevent life-threatening hypoxemia. Understanding the interactions of the multiple pathways producing lung injury and high-permeability edema are important for the prevention and diagnosis as well as for treatment of acute respiratory failure. This may help to minimize the extent of pulmonary and extrapulmonary injury leading to multiple organ system failure, and help to improve patients’ outcome.

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  1. Clinic for Anesthesia and General Intensive Care Medicine, University of Innsbruck, Innsbruck, Austria

    M. Seyr & N. J. Mutz

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  1. Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, DonaueschingenstraĂźe 13, A-1200, Vienna, Austria

    Günther Schlag M. D.  & Heinz Redl Ph. D.  & 

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Seyr, M., Mutz, N.J. (1993). Permeability Changes. In: Schlag, G., Redl, H. (eds) Pathophysiology of Shock, Sepsis, and Organ Failure. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-76736-4_13

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  • DOI: https://doi.org/10.1007/978-3-642-76736-4_13

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