Intestinal platelet trapping after traumatic and septic shock. An early sign of sepsis and multiorgan failure in critically ill patients?

Sigurðsson, Gísli H.; Christenson, Jan T.; El-Rakshy, M.; Sadek, Sameh

doi:10.1097/00003246-199204000-00005

Cited by 51 publications

(28 citation statements)

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“…However, the effects of gastric drainage and abstaining from enteral nutrition have not been shown to be of any significant value in acute pancreatitis while somatostatin probably offers more effective inhibition of the pancreas function [7], Although it makes sense to 'rest' the pancreas in acute pancreatitis, enteral nutrition ad ministered through a jejunostomy tube (placed with an endoscope or through a minilaparotomy) should be con sidered as a supplement to traditional parenteral nutrition in patients without signs of ileus. This is important, because traditional parenteral nutrition does not prevent enteral mucosal atrophy in critically ill patients and trans location of bacteria from the gut in severe pancreatitis may therefore be at risk [26,[82][83][84][85]. The intestinal muco sa is indeed partly dependent upon nutritional supply from the gut lumen for its normal maintenance and func tion [84].…”

Section: Other Supportive Therpaymentioning

confidence: 99%

Intensive Care Management of Acute Pancreatitis

Sigurðsson¹

1994

Dig Surg

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Despite progress in recent years in the diagnostics, surgical treatment and intensive care therapy, severe acute pancreatitis remains a major challenge to the medical profession and a serious threat to the patients. In its most severe form, acute pancreatitis is characterised by a profound inflammatory process in the pancreas leading to partial or total necrosis of the parenchyma. Acute pancreatitis also frequently causes dysfunction of remote organs as well as local complications (pancreatic infection, haemorrhage and pseudocysts). The majority of the attacks of acute pancreatitis (85-90%) are, however, mild and can be dealt with by simple routine treatment. It is essential to identify at an early stage those patients who will develop a severe form of the disease, to allow timely vital organ system monitoring and support in an intensive care unit. Early intervention may have a significant influence on the course of the disease. As soon as the pancreatic inflammation has progressed to necrosis, anti-enzyme or anti-inflammatory therapy and/or treatment which may enhance the pancreatic microcirculation is not likely to change the course of the disease and leaves the treating physician with symptomatic measures only. On arrival to the ICU the patients are frequently hypovolaemic, have diminished blood flow to the abdominal organs, resulting not only in more severe local disease, but also frequently causing failure of remote organs such as the lungs (adult respiratory distress syndrome), kidneys, liver and the intestine (possibly encouraging translocation of enteral bacteria). The aim of therapy in severe pancreatitis is obviously to halt the progress of the local disease and to prevent remote organ failure. So far, very limited experimental and clinical research has been performed on the effects of different modes of intensive care therapy on pancreatic blood flow or on the progress of the panceatic necrosis. Based on clinical experience and available research data, the following procedures are currently recommended in the ICU management of severe pancreatitis. (l)Use invasive monitoring. (2) Optimise oxygen transport by maintaining hyperdynamic circulation (at least during the first 3 days), for example by using isovolaemic or hypervolaemic haemodilution, administration of low dose dopexamine and if necessary other cardio-inotropic drugs. (3) Indications for assisted ventilation should be liberal in order to guarantee high blood oxygen content and to decrease energy expenditure. (4) Start nutrition early to minimise negative nitrogen balance, but avoid overfeeding. (5) Use crystalloids for replacement of insensible fluid loss only and synthetic colloids such as pentastarch for plasma substitution. (6) Provide effective pain relief, for example, by continuous epidural or coeliac block. (7) In cases of extensive necrosis, prophylactic antibiotic therapy (imipenem) should be considered. (8) Follow the clinical course of the patient very closely and monitor the degree of necrosis and possible pancreas infection for tim...

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Section: Other Supportive Therpaymentioning

confidence: 99%

Intensive Care Management of Acute Pancreatitis

Sigurðsson¹

1994

Dig Surg

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“…Under these conditions, the damaged gastrointestinal tract may trap platelets, within its vasculature, predisposing to further leakage of gut flora and endotoxin into the circulation. 44 Such mechanisms could be subject to modulation by individual psychological factors that might influence the equilibrium of inflammatory mediators and set the course of who will survive and who will not.…”

Section: Discussionmentioning

confidence: 99%

Psychological risk factors and early complications after bone marrow transplantation in adults

Szkrumelak

1999

Bone Marrow Transplant

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Summary:Complications of bone marrow transplantation can compromise its effectiveness, and often it is not possible to predict who is at greatest risk. In a previous study we reported that certain psychological factors correlated with a high incidence of post-transplant mortality, and here we analyze the associated complications and causes of death. Prior to receiving high-dose chemotherapy and bone marrow transplantation, 112 patients underwent a psychodynamically oriented psychiatric assessment (the 'FIT' assessment). Mortality and associated complications were ascertained by a retrospective chart review. The results of the 'FIT' assessment correlated with the incidence of complications and death, whether or not the transplant was performed for hematologic or solid organ cancers, or was from an allogeneic or autologous source. Most individuals with a high risk profile died of progressive major organ dysfunction or recurrent/refractory neoplastic disease in the first year after transplant. We propose that such a psychiatric assessment might identify a subgroup of individuals in whom pre-emptive therapeutic interventions could be most effective. Keywords: bone marrow transplantation; multiorgan failure; personality assessment; risk assessment; leukemia/lymphoma; cancer of breast and ovary Bone marrow transplantation can reverse the myelotoxicity of high-dose radiation and chemotherapy used in many current strategies to treat cancer. However, sepsis and hemorrhage before engraftment, acute and chronic graftversus-host disease, graft rejection, and late organ dysfunction still limit its effectiveness. 1 Thus, an understanding of predisposing factors that place an individual at risk for such difficulties might enable better control and prevention, and ultimately improve survival.Early in the development of clinical bone marrow transplantation, psychiatrists had recognized that family interactions, coping style, and meaning of the transplant had a profound impact on the individual, 2-5 but not until 1988

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“…With these facts in mind, it is not surprising that circulatory insults to the gastrointesti nal tract (mucosa) can adversely influence its function and. secondarily, the well-being of the patient [3,20,32,33], Critical illness can cause profound mucosal atrophy in the small bowel within 5-7 days in patients and animals [16,34], and it has been shown that splanchnic hypoper fusion during hemorrhagic shock and even during normodynamic sepsis cause microvascular injury' and gut-muco sal ischemia in animals [35][36][37], To study whether muco sal atrophy is associated with intestinal microcirculatory injury in critically ill patients, radiolabeled platelets were used as a marker of endothelial injury (they stick to subendothclial structures) [29], Indium-111-oxine-labeled au tologous platelets were followed daily in various organs using cadmium telluride minidetectors connected to preamplifiers and a microcomputer (custom-built mobile unit). The external imaging was done over the brain, mus cle, heart, lung, liver, spleen, kidneys and intestine.…”

Section: Platelet Sequestration In Multiple Organs After Septic Shockmentioning

confidence: 99%

“…The external imaging was done over the brain, mus cle, heart, lung, liver, spleen, kidneys and intestine. Only high-risk patients who had been in severe shock, had high injury' severity scores (1SS = 50) and/or high APACHE II scores and were therefore at high risk of developing sepsis and MOF [29] were studied.…”

Section: Platelet Sequestration In Multiple Organs After Septic Shockmentioning

confidence: 99%

Microcirculation in the Gastrointestinal Tract

Sigurðsson¹,

Banič

Christenson

1996

Dig Surg

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Sepsis and multiple-organ failure (MOF) are associated with a prolonged stay and high mortality rate in surgical intensive-care units. In recent years the occurrence of MOF has been linked with previous hypoperfusion of the gut during a variety of critical conditions. In the present study, we focused on the blood flow pattern (rather than the quantity of flow) in the mucosal microcirculation of the gastrointestinal tract during surgery and hemorrhagic shock. In anesthetized pigs subjected to laparotomy and hemorrhage, mucosal blood flow was continuously recorded using multichannel laser Doppler flowmetry (LDF). During normovolemic conditions, flowmotion at a rate of 3-5 cycles per minute occurred in the gastric, jejunal and colonic mucosa in all the animals. The flowmotion disappeared during severe blood loss and during administration of catecholamines. These results suggest that flowmotion, as measured by LDF, is a normal phenomenon in the mucosa of the gastrointestinal tract, but is disrupted during shock. The physiological and clinical significance of these findings awaits further studies.

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Intestinal platelet trapping after traumatic and septic shock. An early sign of sepsis and multiorgan failure in critically ill patients?

Cited by 51 publications

References 0 publications

Intensive Care Management of Acute Pancreatitis

Intensive Care Management of Acute Pancreatitis

Psychological risk factors and early complications after bone marrow transplantation in adults

Microcirculation in the Gastrointestinal Tract

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