Sepsis and Organ Dysfunction The Challenge Continues
Springer-Verlag Italia Srl.
A.E. Baue G. Berlot A.Gullo J.-L. Vincent (Eds)
Sepsis and Organ Dysfunction The Challenge Continues
ORGAN FAILURE ACADEMY
Springer
A.E.
BAUE,
M.D.
Department of Surgery, Saint Louis University, Health Sciences Center, St. Louis - USA
G. BERLOT, M.D. Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste - Italy
A.
GULLO,
M.D.
Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste - Italy
J.-L.
VINCENT,
M.D.
Department of Intensive Care, Erasme University Hospital Free University of Brussels - Belgium 1 - 34125 TRIESTE Steering Committee A.E. Baue, M.D., Department of Surgery, Saint Louis University Health Sciences Center, St. Louis - USA
O.F.A. - ORGAN F AILURE A CADEMY, VIA B ATIISTI ,
(ITALY)
G. Berlot, M.D., Department of Anaesthesia, Intensive Care and Pain Therapy University ofTrieste, Cattinara Hospital , Trieste . Italy A. Gullo, M.D., Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste - Italy L. Silvestri, M.D., Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste - Italy G. Sganga, M.D. , Department of Surgery, and C.N.R. Shock Centre Catholic University of Sacro Cuore, Rome . Italy
© Springer-Verlag Italia 2000 Originally published by Springer-Verlag Italia, Milano 2000 ISBN 978-88-470-0096-4 ISBN 978-88-470-2284-3 (eBook) DOI 10.1007/978-88-470-2284-3
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SPIN: 10753508
Table of Contents
Introduction A.E. BAUE....................................................................................................................................
11
Sepsis and Organ Dysfunction. The Challenge Continues G. BERLOT, U. LUCANGELO, AND A. GULLO ................................................................................
17
OXYGEN TRANSPORT IN SEPSIS Biochemical Regulation of the Microcirculation G.P. NOVELLI ...............................................................................................................................
37
Oxygen Supply and Consumption in Tissues A. MAYR, W. PAIK, AND W. HASIBEDER ........ ............ ...... .................. .................. ........ ...... ..........
43
Ischaemia-Reperfusion in Sepsis C. ADEMBRI, A.R. DE GAUDIO, AND G.P. NOVELLI .....................................................................
49
Mechanism of Oxygen Extraction Defect in Septic Shock W. PAlK, H. KNOTZER, AND W. HASIBEDER.. .......................... ...... ...... ........ ...... .................... .......
57
ORGAN DYSFUNCTION AND BIOHUMORAL MISMATCH IN SEPSIS Gut Perfusion in Sepsis and Shock J.F. PALIZAS .................................................................................................................................
67
Pathophysiology of Encephalopathy N. LATRONICO, G.F. BUSSI, AND A. CANDIANI.............................................................................
77
Lung Dysfunction in the Early Phase of Sepsis P. NEUMANN ..................................... '" ................... , ... ... ... ... ......... ... ......... ... ...... ... ... ... ... ... ..... ... ....
85
The Kidney in Sepsis J.A. KELLUM................................................................................................................................
91
Pathophysiology of Liver Dysfunction in Sepsis N. BRIENZA .................................................................................................................................. 103
Inflammatory Cells in Septic Shock H. ZHANG, C. HSIA, AND G. PORRO ............................................................................................. 107 SEPSIS TRIAL "Revised Terminology on Sepsis J.-L. VINCENT ............................................................................................................................... 115
VI
The Epidemiology and Outcome of Patients with Sepsis: Clear as Mud R.S. WAX, AND D.e. ANGUS .......................................................................................................
123
Are there Useful New Markers of Sepsis? K. REINHART ................................................................................................... 137
M. MEISNER, AND
A Paradigm Shift: The Bidirectional Effect of Inflammation on Bacterial Growth G.U. MEDURI ............................................................................................................................... 145 Is the Dosing and Timing of the Intervention Adequate? A.F. SUFFREDINI ........................................................................................................................... 155
Clinical Trials of Mediator-Targeted Therapy in Sepsis J.e. MARSHALL ............................................................................................................................ 161
Index ........................................................................................................................................... 175
Authors Index
Adembri C. Department of Anaesthesiology and Intensive Care, Florence University School of Medicine, Florence (Italy)
Angus D.C.
Department of Anaesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (U.S.A.)
BaueA.E.
Department of Surgery, St. Louis University Medical Centre, St. Louis, Missouri (U.S.A.)
Berlot G.
Department of Anaesthesiology and Intensive Care, Trieste University School of Medicine, Trieste (Italy)
Brienza N.
Department of Anaesthesia and Intensive Care, Bari University School of Medicine, Bari (Italy)
Bussi G.F. Department of Anaesthesia and Intensive Care, University of Brescia, Brescia (Italy)
CandianiA. Department of Anaesthesia and Intensive Care, University of Brescia, Brescia (Italy)
De Gaudio A.R.
Department of Anaesthesiology and Intensive Care, Florence University School of Medicine, Florence (Italy)
GulloA.
Department of Anaesthesiology and Intensive Care, Trieste University School of Medicine, Trieste (Italy)
Hasibeder W.
Department of Anaesthesia and General Critical Care Medicine, The Leopold Franzens University of Innsbruck, Innsbruck (Austria)
Hsia C.
Division of Respiratory Medicine, Mount Sinai Hospital, Toronto University, Toronto, Ontario (Canada)
Kellum J.A.
Department of Anaesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (U.S.A.)
Knotzer H.
Department of Anaesthesia and General Critical Care Medicine, The Leopold Franzens University of Innsbruck, Innsbruck (Austria)
Latronico N.
Department of Anaesthesia and Intensive Care, University of Brescia, Brescia (Italy)
Lucangelo U.
Department of Anaesthesiology and Intensive Care, Trieste University School of Medicine, Trieste (Italy)
Marshall J.C.
Department of Surgery, The University of Toronto, Toronto General Hospital, University Health Network, Toronto, Ontario (Canada)
VIII
MayrA. Department of Anaesthesia and General Critical Care Medicine, The Leopold Franzens University of Innsbruck, Innsbruck (Austria)
Meduri G.D.
Department of Medicine, Pulmonary and Critical Care Division, University of Tennessee Medical Centre, Memphis, Tennessee (U.S.A.)
Meisner M.
Department of Anaesthesiology and Intensive Care Therapy, University Hospital, lena (Germany)
Neumann P.
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Hospital, Giittingen (Germany)
Novelli G.P.
Department of Anaesthesiology and Intensive Care, Florence University School of Medicine, Florence (Italy)
Pajk W. Department of Anaesthesia and General Critical Care Medicine, The Leopold Franzens University of Innsbruck, Innsbruck (Austria)
Palizas J.F.
Department of Intensive Care, Bazterrica Clinic, Buenos Aires (Argentina)
Porro G.
Division of Respiratory Medicine, Mount Sinai Hospital, Toronto University, Toronto, Ontario (Canada)
Reinhart K.
Department of Anaesthesiology and Intensive Care Therapy, University Hospital, lena (Germany)
Suffredini A.F.
Department of Critical Care Medicine, National Institute of Health, Bethesda, Maryland (U.S.A.)
Vincent J.-L.
Department of Intensive Care, Free University of Bruxelles, Erasme Hospital, Bruxelles (Belgium)
Wax R.S.
Department of Anaesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (U.S.A.)
Zhang H.
Division of Respiratory Medicine, Mount Sinai Hospital, Toronto University, Toronto, Ontario (Canada)
Abbreviations
AAA, aromatic amino acids
HNP-1-3, human neutrophil peptide
ALT, alanine aminotransferase
IL-l, interleukin-l
ARDS, acute respiratory distress syndrome
INF -')', interferon-y
ARF, acute respiratory failure
iNOS, inducible NO synthase
AST, aspartate aminotransferase
I-R, ischaemia-reperfusion
ATN, acute tubular necrosis
LBP, lipopolysaccharide binding protein
ATP, adenosine-triphosphate
LOCM, low-osmolality contrast media
BAL, bronchoalveolar lavage
LPS, lipopolysaccharide
BALF, bronchoalveolar lavage fluid
MAP, mean arterial pressure
BBB, blood-brain barrier BCAA, branched chain amino acid BPI, bactericidal permeability increasing protein
CARS, compensatory anti-inflammatory response syndrome
MARS, mixed inflammatory and anti-inflammatory response syndrome
MIP-2, macrophage inflammatory protein-2 MODS, multiple organ dysfunction syndrome MOF, multiple organ failure NMMA, N-monomethyl arginine
CBF, cerebral blood flow
NO, nitric oxide
CMR02 , cerebral metabolic rate of oxygen
OR, oxygen radical
CNS, central nervous system eNOS, constitutive NO synthase CRP, C-reactive protein
CSF, cerebrospinal fluid DIC, disseminated intravascular coagulation EAA, excitatory amino acids
PAF, platelet activating factor PA0 2 , alveolar oxygen tension PE, plasmapheresis PMNs, polymorphonuclear granulocytes!cells RBF, renal blood flow RVR, renal vascular resistance
ENDOCAB, endotoxin core antibody
SAO/R, splanchnic artery occlusion and reperfusion
FOR, free oxygen radicals
SE, septic encephalopathy
GABA, y-aminobutyric acid
SIRS, systemic inflammatory response syn-
G-CSF, granulocyte colony stimulating factor
drome
GFR, glomerular filtration rate
TFPI, tissue factor pathway inhibition
GM-CSF, granulocyte-macrophage colony-
TNF, tumour necrosis factor
stimulating factor
YAP, ventilator-associated pneumonia
HDR, host defense response
XD, xanthine dehydrogenase
HMG-l, high mobility group-l protein
XO, xanthine oxidase
