PMID- 9407239
OWN - NLM
STAT- MEDLINE
DCOM- 19980122
LR  - 20190826
IS  - 0342-4642 (Print)
IS  - 0342-4642 (Linking)
VI  - 23
IP  - 10
DP  - 1997 Oct
TI  - Is endotoxin and cytokine release related to a decrease in gastric intramucosal 
      pH after hemorrhagic shock?
PG  - 1040-8
AB  - OBJECTIVES: (a) To investigate the relationship between gut ischemia parameters 
      (gastric intramucosal pH [pHi], mucosal-arterial carbon dioxide difference 
      [PCO2-gap]), and endotoxin or cytokine release during hemorrhagic shock; (b) to 
      compare the predictive value of pHi, PCO2-gap and arterial lactate 
      concentrations. DESIGN: Prospective study. SETTING: Surgical intensive care unit 
      of a university hospital. PATIENTS: 20 multiple trauma patients with severe 
      hemorrhagic shock. INTERVENTIONS: Intramucosal measurements and blood samples 
      were obtained on admission to the emergency room and repeatedly over 48 h. 
      MEASUREMENTS AND RESULTS: Endotoxin was measured using a chromogenic limulus 
      amoebocyte assay. Cytokine [tumor necrosis factor-alpha (TNF alpha) and 
      interleukin-6 (IL-6)] values were evaluated by immunoradiometric assays. Only 3 
      patients had positive blood cultures but endotoxins were detected at least once 
      in all patients. Endotoxin levels were similar in survivors and non-survivors 
      over the study period and were not related to pHi or PCO2-gap. Initially, high 
      levels of IL-6 were observed in both nonsurvivors and survivors [median 1778 
      pg/ml (range 435-44,540) vs 2068 pg/ml (range 996-92,300)]. IL-6 levels 
      progressively decreased in the survivors but not significantly. On admission, TNF 
      alpha concentrations were similar in nonsurvivors and survivors (42 +/- 35 vs 46 
      +/- 27 pg/ml). From the 24th h, TNF alpha values were higher in the nonsurvivors 
      than in the survivors (24 h: 72 +/- 38 vs 34 +/- 17 pg/ml, p < 0.05). The 
      greatest IL-6 levels were found for a pHi < 7.20 (28.5 +/- 36.5 vs 1.8 +/- 1.3 
      ng/ml, p < 0.05) or a PCO2-gap > 7.5 mmHg (1 kPa) (32.5 +/- 37.5 vs 1.7 +/- 1.3 
      ng/ml, p < 0.01). With the same pHi threshold, no difference was found in 
      endotoxin levels. The lactate concentrations were predictive for outcome from the 
      12th h (9.5 +/- 5.9 vs 3.6 +/- 2.3 mmol/l, p < 0.05). CONCLUSIONS: During severe 
      hemorrhagic shock, endotoxin translocation from the gut was a common phenomenon 
      that seemed independent of both pHi values and outcome. It could not explain IL-6 
      and TNF alpha release. In severe hemorrhagic shock, neither pHi nor PCO2-gap 
      provides additional information to the lactate measurements.
FAU - Charpentier, C
AU  - Charpentier C
AD  - Department of Anesthesia and Surgical Intensive Care, Hopital Central, Nancy, 
      France.
FAU - Audibert, G
AU  - Audibert G
FAU - Dousset, B
AU  - Dousset B
FAU - Weber, M
AU  - Weber M
FAU - Garric, J
AU  - Garric J
FAU - Welfringer, P
AU  - Welfringer P
FAU - Laxenaire, M C
AU  - Laxenaire MC
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Intensive Care Med
JT  - Intensive care medicine
JID - 7704851
RN  - 0 (Cytokines)
RN  - 0 (Endotoxins)
RN  - 0 (Lactates)
RN  - 142M471B3J (Carbon Dioxide)
SB  - IM
MH  - Adult
MH  - Bacterial Translocation/physiology
MH  - Carbon Dioxide/metabolism
MH  - Cytokines/*blood
MH  - Endotoxins/*blood
MH  - Female
MH  - Gastric Mucosa/*metabolism
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Intensive Care Units
MH  - Lactates/blood
MH  - Male
MH  - Middle Aged
MH  - Multiple Trauma/*metabolism/mortality
MH  - Predictive Value of Tests
MH  - Severity of Illness Index
MH  - Shock, Hemorrhagic/*metabolism/mortality
EDAT- 1998/01/04 00:00
MHDA- 1998/01/04 00:01
CRDT- 1998/01/04 00:00
PHST- 1998/01/04 00:00 [pubmed]
PHST- 1998/01/04 00:01 [medline]
PHST- 1998/01/04 00:00 [entrez]
AID - 10.1007/s001340050454 [doi]
PST - ppublish
SO  - Intensive Care Med. 1997 Oct;23(10):1040-8. doi: 10.1007/s001340050454.