No abstract

Multiple organ failure (MOF) secondary to sepsis is associated with a high mortality. A large body of evidence suggests that the disturbed relationship between oxygen supply and oxygen uptake plays an important role in the pathogenesis of MOF. The relationship between oxygen-supply dependency and MOF and the practical implications of the relationship are reviewed. It is concluded that, apart from the all-important eradication of the source of the sepsis, optimizing oxygen transport is the best method of preventing the development of MOF. Since the effects of hemodynamic and ventilatory treatments on oxygen uptake are often unpredictable, the impact of the treatments on oxygen uptake should be evaluated directly.

JM van der Klooster, AF Grootendorst, JW Brouwers, A Late Presentation of Postpneumonectomy Pleural Empyema and Bronchopleural Fistula. 1998; 18(6): 567-569 To the Editor. Bronchopleural fistula (BPF) is a rare but serious complication after pneumonectomy. The recognition and diagnosis of bronchial stump disruption can be very difficult and may lead to a delay in the management of this life-threatening condition. Modern high-technology imaging techniques, such as fiberoptic bronchoscopy, computed tomography and ventilation scintigraphy, are generally used to identify the site of persistent air leakage. Bronchography is rarely of value in detecting small leaks, but has been useful in the demonstration of large ones. 1 We would like to highlight the use of methylene blue as a safe, effective and relatively noninvasive means of confirming the diagnosis of an occult postpneumonectomy BPF with pleural empyema. Little attention has been paid to this simple bedside test since 1955, when Franz et al. reported a 33.3% yield in their 24 patients who had pulmonary resections.2 As most cases of postpneu-monectomy BPF develop within days, weeks, or at the most, months of the operation, it should be noted that our case is an unusual late-presenting variant.