Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Editorial Review
Multiple organ failure, multiple organ dysfunction syndrome, and the systemic inflammatory response syndrome-where do we stand?
Multiple organ failure, multiple organ dysfunction syndrome, and the systemic inflammatory response syndrome are problems of medical progress and intensive care units (ICUs) and require prevention of organ failure through excellent patient care. New concepts in prevention include: 1) the need to improve microcirculatory blood flow (Mbf) early after injury or illness, 2) stopping or controlling injury or infection by early definitive operation when necessary, 3) a zero defect operation is necessary, 4) necrotic tissue and an overwhelming inflammatory burden are problems and should be lessened when possible, 5) adequate resuscitation to improve Do2, Vo2, and organ blood flow is necessary, 6) supporting metabolism and the GI tract may decrease complications of injury and sepsis, 7) support of host defense and/or immunomodulation to decrease the incidence of sepsis, and 8) treating the patient and the illness or injury, not just the mediators. Experimental evidence in animals and human volunteers for concepts, mechanisms, and treatment of injury or illness can be substantial and persuasive, but it may be difficult to demonstrate efficacy in sick patients. ⋯ A single magic bullet for complex and diverse illnesses is not likely to appear or to be successful. In this review it was not possible to describe many of the observations and recommendations in this immense and complex field. I apologize to those whose work I have inadvertently not included.
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Comparative Study
The effects of plasma and albumin infusion on organ function and sepsis markers in experimental gram-negative sepsis.
To study the effects of early plasma versus albumin infusion on vital organ function and the appearance of central sepsis mediators in septic shock, three groups of anesthetized piglets (n = 28) were inoculated with live Eschericia coli. Group I received fresh frozen plasma, group II received albumin, whereas group III served as nontreated septic controls. Plasma-treated animals exhibited improved survival (p < .02) compared with controls, and improved organ function compared with both controls and albumin-treated animals. ⋯ Following albumin infusion TNF levels decreased to baseline values (p < .01), whereas endotoxin and TCC levels did not change significantly. Our study shows a beneficial effect of early plasma infusion on survival and vital organ function in septic animals. The effect of plasma infusion on circulating levels of endotoxin, TNF, and TCC may be potentially deleterious in uncompensated stages of septic shock.