Effect of major abdominal surgery on endotoxin release and expression of Toll-like receptors 2/4

Abstract

Major abdominal surgery is associated with endotoxemia, reduced capability of plasma to inactivate endotoxin, cytokine kinetics resembling those of healthy man after experimentally given LPS, and substantial acute-phase reaction. The cytokine liberation of mononuclear cells suggests a state of postoperative endotoxin tolerance. Despite these substantial changes, trends in TLR2/4 expression are not obvious.

Mild Endotoxemia during Mechanical Ventilation Produces Spatially Heterogeneous Pulmonary Neutrophilic Inflammation in Sheep

“…For example, lung inflammation may be reduced by PEEP and lower tidal volumes49, despite the presence of a pro-inflammatory response even during mild mechanical ventilation50. Also, in contrast to controlled ventilation, noisy pressure support ventilation could modify inflammation by changing lung mechanics and gas exchange25, 26; 3) effects of mechanical ventilation in normal and injured lungs: mechanical ventilation with low and high tidal volumes affect lungs differently, depending on their previous degree of injury51, 52. Consequently, regional inflammation magnitude and distribution may differ in the case of previously injured lungs or lungs affected by other injurious mechanisms51; 4) interference with anesthesia: because both inhaled53 and intravenous54, 55 anesthetic agents can modulate inflammation, use of different anesthetic regimens could modify the observed inflammatory pattern.…”

Prevalence of endotoxemia after surgery and its association with ICU length of stay

“…Meanwhile, postural changes, blood loss, and vasoplegia all cause relative or absolute hypoperfusion that may favor bacterial translocation. Buttenschoen and colleagues have in fact shown that major abdominal surgery is associated with transient endotoxemia [ 13 , 14 ]. However, while the likelihood of endotoxemia might be straightforward in major abdominal surgery, less is known in other surgical procedures, apart from cardiopulmonary bypass [ 15 , 16 ].…”

Stimulation of TLR7 prior to polymicrobial sepsis improves the immune control of the inflammatory response in adult mice

“…In the postoperative period, the pattern of cytokine release by human immune competent cells suggests postoperative endotoxin tolerance [21]. As shown by Sato et al [12], this effect is not restricted to pre-treatment with TLR4-agonists, as R-848 pre-treated peritoneal macrophages synthesize lower amounts of pro-inflammatory cytokines on stimulation with LPS.…”