Pathophysiology of Shock, Sepsis, and Organ Failure

ISBN-13: 9783642767388 / Angielski / Miękka / 2011 / 1165 str.

Gunther Schlag; Heinz Redl

Opis

In this book current knowledge of the pathophysiology of shock, sepsis and multi organ failure is presented. The rapid progress which has been made and the results achieved in intensive care medicine are based on sound basic research, which is duly reflected in these chapters. Multiorgan failure is the foremost cause of postoperative and posttraumatic death and many complex mechanisms are involved. Only with a good foundation of basic research can abnormalities in the physiological, biochemical, and morphological course of shock be recognized and the necessary conclusions for treatment drawn. Therapy must proceed from profound knowledge of the multi variant physiological events in order to influence shock, sepsis and organ failure. Although numerous possibilities for therapy have arisen from pharmaceutical research in recent years, they are beyond the scope of this book and are not discussed here. To gain a better understanding of the pathophysiological events it was necessary to examine and to describe different models that simulate and reproduce these events. Here we describe the causative agents (shock) and the consequences (sepsis, organ failure) in two main sections, divided on the basis of their pathophysiology.

Spis treści

Introduction: “Organ in Shock”, “Early Organ Failure”, “Late Organ Failure”.- Trauma, Shock and Development of the Organ in Shock and Early Organ Failure (SIRS).- Shock, Sepsis, and Multiple Organ Failure: The Result of Whole-Body Inflammation.- The Role of Complement.- Activation of Humoral Systems. The Role of Coagulation, Fibrinolysis, and the Plasma Kallikrein-Kinin System.- Proteinases.- Cellular Mechanisms of Leukocyte Adhesion.- Eicosanoids in Trauma and Traumatic Shock.- Radical Related Cell Injury.- Humoral Mechanisms.- Monocyte and Lymphocyte Responses Following Trauma.- Metabolic Response to Trauma.- Morphology of the Lung as a Consequence of Direct and Indirect Trauma.- Permeability Changes.- Cardiac Function During Hypovolemia.- Cardiodepressant Factors.- Response of the Macrocirculation.- Response of the Microcirculation: Tissue Oxygenation.- Cardiovascular Function in Acute Burns.- Morphology of the Liver in Shock.- Bacterial Translocation.- Bacterial Translocation During Traumatic Shock in Baboons.- Bacterial Translocation in Polytrauma Patients.- Bacterial Translocation in Burns.- Hypoxic Damage.- Reperfusion Injury in the Small Intestine.- Kidney Blood Flow Changes in Shock.- Central Nervous System Response to Trauma.- Rat and Mouse Models of Hypovolemic-Traumatic Shock.- Hypovolemic-Traumatic Shock Models in Baboons.- The Development of the Sepsis and Multi-Organ-Dysfunction-Syndrome (MODS).- The Active Principle of Bacterial Lipopolysaccharides (Endotoxins) for Cytokine Induction.- LPS Plasma Levels in Patients.- Bacterial Exotoxins and Vascular Injury.- Complement in Sepsis.- Activation of Humoral Systems: Coagulation, Fibrinolysis, and Plasma Kallikrein-Kinin Systems.- The Cytokine Network in Trauma and Sepsis I: TNF and IL-8.- The Cytokine Network in Sepsis II: IL-1 and IL-6.- Platelet-Activating Factor in Shock, Sepsis, and Organ Failure.- Endotoxin Activation of Eicosanoid Production by Macrophages.- Proteolytic Enzyme Systems.- Activation/Adherence Phenomena of Leukocytes and Endothelial Cells in Trauma and Sepsis.- Procoagulant Response of the Endothelium and Monocytes.- The Role of the L-Arginine Nitric Oxide Pathway in Sepsis and Endotoxaemia with Special Reference to Vascular Impairment.- Cytokine Modulation of Glucose Metabolism.- Mechanism of Insulin Resistance in Infection.- The Host Defense to Trauma and Sepsis: Multiple Organ Failure as a Manifestation of Host Defense Failure Disease.- Experimentally Induced DIC — DIC as a Cause of MOF.- Three Clinical Presentations of E. coli Sepsis as Studied in the Baboon Model.- Morphology of the Lung in Late Septic Shock.- Morphological Changes in Adult Respiratory Distress Syndrome: Experimental and Clinical Data.- The Role of Respiratory Failure in Multiorgan Failure.- Fibronectin and the Reticuloendothelial System: Relationship to Lung Vascular Failure During Septic Shock.- Abnormalities of the Lung Surfactant System in Acute Lung Injury.- Experimental Models in Surfactant Research.- Myocardial Dysfunction in Experimental Shock.- “Negative Inotropic Cascades” in Cardiomyocytes Triggered by Substances Relevant to Sepsis.- Myocardial Dysfunction in Experimental Septic Shock.- Pathomorphological Aspects of the Heart in Septic Patients.- Clinical Manifestations of Cardiovascular Dysfunction in Sepsis.- Coronary Hemodynamics and Myocardial Metabolism in Sepsis and Septic Shock.- Peripheral Macro- and Microcirculation.- Relationship Between Oxygen Demand and Oxygen Supply in Severe Sepsis.- Hepatic Responses to Bacterial Endotoxin (LPS).- Experimental Liver Failure.- Hepatic Dysfunction in Shock and Organ Failure.- Sepsis Related Renal Morphological Alterations and the Functional Correlates.- The Kidney in Sepsis.- Neurologic Abnormalities in Sepsis.- The Multiple Organ or System Failure Syndrome.- Models of Endotoxemia in Rodents.- Models of Endotoxemia in Sheep.- Rodent Models of Endotoxemia and Sepsis.- Sheep and Pigs as Animal Models of Bacteremia.- Live Escherichia coli Sepsis Models in Baboons.- Animal Models of Endotoxemia and Sepsis.- Models of Sepsis: Subacute Peritonitis in Sheep and Rats.- Chronic Models of Endotoxemia and Sepsis: Lessons from Both a Canine Peritonitis and a Human Endotoxemia Model.