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[Pathomorphologic findings following intensive therapy].

C Ruchti

    Schweizerische Medizinische Wochenschrift
    |May 24, 1986
    PubMed
    Summary
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    Intensive care patients with abdominal disease developed severe lung damage (ARDS) and multiple organ failure, often linked to gram-negative bacterial infections. Cardiovascular patients had less severe outcomes.

    Area of Science:

    • Pathology
    • Intensive Care Medicine
    • Pulmonology

    Background:

    • Autopsy findings in 301 intensive care patients revealed distinct organ damage patterns.
    • Adult Respiratory Distress Syndrome (ARDS) is often caused by lung damage, specifically exudative-to-fibrosing alveolitis (EFA).
    • Long-term intensive care, often due to abdominal disease, was associated with severe EFA.

    Purpose of the Study:

    • To identify and differentiate patterns of organ damage in intensive care unit (ICU) survivors.
    • To correlate specific conditions and treatments with observed pathological findings.
    • To investigate the role of septicemia and bacterial infections in multi-organ damage.

    Main Methods:

    • Post-mortem examination of 301 adult patients.
    • Classification of organ damage based on autopsy findings.

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  • Correlation of pathological findings with clinical history (e.g., duration of ICU stay, primary condition).

    • Main Results:

    • Severe, progressive EFA was observed in patients with prolonged ICU stays, primarily due to abdominal disease.
    • Septicemia, particularly gram-negative bacterial infections, correlated with hemorrhagic diathesis and multiple organ failure.
    • Specific organ damage included renal tubule necrosis, jaundice, splenitis, pneumonia, and liver necrosis.
    • Patients admitted for cardiovascular incidents (shorter ICU stays) showed significantly less EFA, septicemia, and multi-organ damage.
    • Polytraumatized patients presented an intermediate organ damage profile.

    Conclusions:

    • Prolonged intensive care, especially for abdominal disease, increases the risk of severe lung injury and multi-organ failure.
    • Gram-negative bacterial infections are strongly implicated in the pathogenesis of systemic complications in critically ill patients.
    • Clinical context (e.g., cardiovascular vs. abdominal disease, duration of care) significantly influences the pattern and severity of organ damage observed post-mortem.