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Plasma endotoxin and cytokine concentrations in patients with hemorrhagic shock
1Critical Care and Emergency Center, Iwate Medical University, Morioka, Japan.
Objectives:
The roles of cytokines and endotoxin in hemorrhagic shock, particularly the translocation of endotoxin and bacteria during hemorrhagic shock, were investigated.
Design:
Prospective study.
Setting:
Critical care and emergency center of a university hospital.
Patients:
Twenty-nine patients with hemorrhagic shock and 20 healthy controls.
Interventions:
Serial blood samples were collected from both study and control patients. Standard resuscitation techniques were used.
Measurements And Main Results:
Plasma levels of endotoxin and various cytokines were determined repeatedly during hemorrhagic shock. Endotoxin was measured using an endotoxin-specific assay in addition to a new perchloric acid method for pretreatment of plasma. Cytokines were measured by commercial enzyme-linked immunosorbent assays. Plasma endotoxin concentrations remained within the normal range for 7 days after admission. Although levels of tumor necrosis factor-alpha and several interleukins increased slightly in some patients, these cytokines did not reach the levels seen in septic shock.
Conclusions:
Translocation of bacteria or endotoxin from the gastrointestinal tract into the bloodstream has been noted in animal experiments; however, translocation was not detected in our patients with hemorrhagic shock.