Postburn gastrointestinal vasoconstriction increases bacterial and endotoxin translocation

Abstract

Splanchnic ischemia has been associated with bacterial translocation and increased endotoxin absorption from the gut. To study the effects of major burn on splanchnic circulation, minipigs were randomized to receive 40% flame burn and Parkland resuscitation or sham burn and maintenance fluids. Total and fractionated blood flow, O2 delivery and consumption, mucosal pH of the intestine, and endotoxin levels in the superior mesenteric vein were measured for 48 h, and then abdominal organs were harvested for bacteriological culture and histopathological analysis. Total mesenteric blood flow and fractionated blood flow to the mucosa-submucosa of the jejunum, cecum, and colon decreased 2 and 4 h postburn. Although mesenteric O2 consumption was unchanged, mesenteric O2 delivery and intestinal mucosal pH were decreased during the early postburn period. Concomitantly, endotoxin levels in the superior mesenteric vein were significantly elevated during the first 8 h postburn. The bacteriological cultures of the systemic tissue samples showed increased bacterial translocation in the burn group. After major burns, there is a transient selective splanchnic vasoconstriction, which is associated with intestinal mucosal acidosis and increased incidence of bacterial translocation and endotoxin absorption from the gut.

TLR4 inactivation and rBPI21 block burn-induced myocardial contractile dysfunction

“…Both the ileum and colon contain large numbers of gram-negative organisms at higher densities than other body sites, including the skin and oropharynx. Bacterial translocation to extraintestinal sites (such as the mesenteric lymph nodes, spleen, and liver) can occur after burn injury (8,29,57). Furthermore, other shock states, such as hemorrhagic shock, can also lead to endotoxemia, bacterial translocation (3,20,45,46), and myocardial dysfunction (5,14,51).…”

“…Many of these studies, however, have been complicated by the inability to document endotoxemia consistently after burn injury. Endotoxin has been detected in the first hour after burn injury in both patients (11,60,62) and experimental animals (8,57,67). In general, postburn endotoxemia has been seen after large burns accompanied by inadequate fluid resuscitation or in a burn injury model, with aggressive fluid resuscitation, complicated by sepsis (49).…”

Alcohol ingestion before burn injury decreases splanchnic blood flow and oxygen delivery

“…This results in tissue hypoperfusion, leading to hypoxic conditions. Studies have shown that hepatocellular, intestinal, and renal dysfunctions occur early after burn, trauma, and hemorrhagic shock and that these dysfunctions are associated with tissue hypoperfusion (1,16,20,30,33,34). Similarly, alcohol ingestion has also been shown to influence hemodynamic responses (9,11,12,22,28).…”

Lack of Correlation Between Failure of Gut Barrier Function and Septic Complications After Major Upper Gastrointestinal Surgery

“…This concept is supported by data from animal studies in experimental models, including surgical trauma, 2 malnutrition, 3,4 jaundice, 5 pancreatitis, 6 -8 hemorrhagic shock, 9,10 and thermal injury. [11][12][13] These studies have demonstrated the presence of bacterial translocation as measured by the recovery of viable enteric organisms from regional lymph nodes, liver, and other organs, increased intestinal permeability to macromolecules, and systemic endotoxemia.…”