Lymphatic dysfunction in critical illness

Abstract

Purpose of review The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well-recognized, however there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions. Recent findings The mainstay of current therapies for congenital and acquired lymphatic abnormalities has involved non-specific medical management or surgical procedures to obstruct or divert lymphatic flow. With the development of dynamic contrast-enhanced magnetic resonance lymphangiography, image-directed percutaneous intervention may largely replace surgery. Because of new insights into the mechanisms that regulate lymphatic biology, pharmacologic inhibitors of mTOR and leukotriene B4 signaling are each in Phase II clinical trials to treat abnormal lymphatic structure and function, respectively. Summary As our understanding of normal lymphatic biology continues to advance, we will be able to develop novel strategies to support and augment lymphatic function during critical illness and through convalescence.

Diagnosing capillary leak in critically ill patients: development of an innovative scoring instrument for non-invasive detection

“…interstitial hypervolemia) from CLS is formed by fluid shift from intra- to extravascular space. Extravascular fluid returns back to the circulation by lymphatic pathways which can be influenced by drugs used in intensive care medicine [ 32 ]. With an approximated surface area of 7,000m 2 [ 33 ], the endothelium accounts for a considerable area of exchange.…”