Hemodynamic Changes and Gut Barrier Function in Sequential Hemorrhagic and Endotoxic Shock

Abstract

Multisystem organ failure (MSOF) is the major cause of late death following trauma. The gut is hypothesized to be the source of an ongoing systemic inflammatory response that drives MSOF. It has also been suggested that while a single physiologic insult might not reliably cause MSOF, the addition of a delayed second stress will. This is known as the "two-hit" theory. The purpose of this study was to investigate the two-hit theory by observing the hemodynamic and bacteriologic response to a second stress in a subacute pig model of hemorrhagic and endotoxic shock. Swine (n = 18, 30-40 kg) were fed an antibiotic-free diet for 14 days. During instrumentation and experimentation on days 1 and 3, all animals were anesthetized (ketamine, isofluorane). On day 1, all animals had placement of central venous and arterial catheters, a portal venous catheter, and superior mesenteric artery flow probe. Group E (n = 6) underwent instrumentation on day 1, then infusion of endotoxin (25 mcg/kg E. coli lipopolysaccharide) on day 3. Group HE (n = 7) underwent instrumentation then hemorrhagic shock (mean arterial pressure = 40 mm Hg for 4 hours) on day 1, then infusion of endotoxin on day 3. Group H (n = 5) were instrumented and hemorrhaged on day 1, and underwent anesthesia only on Day 3. Between periods of anesthesia the animals were allowed food and water ad lib and systemic blood was sampled for culture every 12 hours. On day 5, the animals were euthanized prior to organ sampling for bacterial culture. One animal from group HE died during endotoxic shock on day 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Porcine Two-Hit Model with Hemorrhagic Shock and <i>Pseudomonas aeruginosa</i> Sepsis

“…Microvascular changes are one explanation of the 'twohit' theory of multiple organ failure [17][18][19][20]. Gelfand et al [21] support the concept that the hemorraghic shock accounts for the septic complication, since they did not find any significant bacterial translocation within 6 h of hemorrhagic shock in the pig.…”

Decreased α-Adrenergic Response in the Intestinal Microcirculation after “Two-Hit” Hemorrhage/Resuscitation and Bacteremia

“…However, physiologic responses to two-hit models have not been well characterized [11][12][13]. Using aortic rings, Price et al have recently demonstrated that prior H/R alters vascular responsiveness following bacteremia [15].…”

Continuous measurements of microcirculatory blood flow in gastrointestinal organs during acute haemorrhage

“…11 morbidity and mortality in critically ill patients. 1 2 It is believed that hypoperfusion of splanchnic organs, [3][4][5] During acute haemorrhage, the splanchnic circulation is greatly affected by local and systemic regulatory resulting from trauma, haemorrhage or disease, is an important contributor to the development of multiple organ mechanisms, which may cause immediate and sustained hypoperfusion of the gastrointestinal tract. 12 Although failure (MOF) and death.…”