Are we Making Progress in Preventing and Treating MOF?

  • Arthur E. Baue

Abstract

We like to think that we are improving the care of injured and operated patients so more patients survive and recover.1 Certainly regional trauma centers, better monitoring and intensive care, new drugs, improved operative surgery, and minimal surgical procedures have improved the possibilities of survival of our patients.2 During an era in which “evidence-based medicine”3 and “evidence-based research”4 are stressed, can we document objectively such improvements in patient care if they truly have occurred? Prospective, randomized, double-blind clinical trials are required to document the efficacy of various therapeutic efforts. Unfortunately, many, if not all, such studies of a single “magic bullet” have been negative.5 It is difficult to measure and document whether general resuscitation, operations, and intensive care have made an impact on survival and well-being. Controlled randomized trials are not possible. What would be the variable? Randomized to what?

Keywords

Aspirin Pancreatitis Catecholamine Dextran Peritonitis 

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References

  1. 1.
    Baue AE, Durham RM, Faist E: Systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), multiple organ failure (MOF): are we winning the battle? Shock 1998; 10: 79–89.PubMedCrossRefGoogle Scholar
  2. 2.
    Baue AE: Multiple organ failure, multiple organ dysfunction syndrome and the systemic inflammatory response syndrome: where do we stand? Shock 1994; 2: 385–339.PubMedCrossRefGoogle Scholar
  3. 3.
    Sackett D, Rosenberg W: The need for evidence-based medicine. J R Soc Med 1995; 88: 620–624.PubMedGoogle Scholar
  4. 4.
    Piper R, Cook D, Bone R, Sibblad W: Introducing critical appraisal to studies of animal models investigating novel therapies in sepsis. Crit Care Med 1996; 24: 2059–2070.PubMedCrossRefGoogle Scholar
  5. 5.
    Baue AE: Multiple organ failure, multiple organ dysfunction syndrome, and the systemic inflammatory response syndrome: why no magic bullets? Arch Surg 1997; 132: 703–707.PubMedCrossRefGoogle Scholar
  6. 6.
    Baue AE: Whatis clinical relevance? In: Baue AE, Berlot E, Gullo A, Vincent JL (ed) Sepsis and Organ Dysfunction. Milano, Springer, 1997; 95–104.Google Scholar
  7. 7.
    Zimmerman J, Knaus W, Wagner D, et al: A comparison of risks and outcomes for patients with organ system failure: 1982-1990. Crit Care Med 1996; 24: 1633–1641.PubMedCrossRefGoogle Scholar
  8. 8.
    Christou N, Meakins J, Gordon J, et al: The delayed hypersensitivityresponse and host resistance in surgical patients 20 years later. Ann Surg 1995; 222: 534–548.PubMedGoogle Scholar
  9. 9.
    Regel G, Lobenhofler P, Grotz M, et al: Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 ata German level I trauma center. J Trauma 1995; 38: 70–78.PubMedCrossRefGoogle Scholar
  10. 10.
    Offner P, Moore F, Sauaia A, Moore E: Temporal trends in postinjury MOF incidence and outcome. J Trauma (in press)Google Scholar
  11. 11.
    Ali J, Adam R, Gana T, Williams J: Trauma patient outcome after tihe prehospital trauma life support program. J Trauma 1997; 42: 1018–1022.PubMedCrossRefGoogle Scholar
  12. 12.
    O’Keefe GE, Jurkovich GJ, Maier RV: 10-Year trends in costs, resource utilization, and survival outcome in an established trauma center. Surg Forum 1997; 48: 595–597.Google Scholar
  13. 13.
    Hudson-Civetta J, Civetta J, Kirton O, et al: Mitigating increased severity of illness in trauma patients. Crit Care Med 1998; 26: A94.CrossRefGoogle Scholar
  14. 14.
    Shuman RB, Schuster DP, Zuckerman GR: Prophylactic therapy for stress bleeding: a reappraisal. Ann Intern Med 1987; 106: 562–567.PubMedGoogle Scholar
  15. 15.
    Goris RJA, Gimbrere JSF, van Niekerk JLM, et al: Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 1982; 22: 895.PubMedCrossRefGoogle Scholar
  16. 16.
    Pape HC, Auf’m’Kolk M, Paffrath T, et al: Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion: a cause of post-traumatic ARDS? J Trauma 1993; 34: 540–548.PubMedCrossRefGoogle Scholar
  17. 17.
    Pelias ME, Townsend C, Flancbaum L: Long bone fractures predispose to pulmonary dysfunction in blunt chest trauma despite early operative fixation. Surgery 1992; 111: 576–579.PubMedGoogle Scholar
  18. 18.
    Phillips JO, Metzler MH, Palmieri MTL, et al: A prospective study of simplified omeprazole suspension for the prophylaxis of stress-related mucosal damage. Crit Care Med 1996; 24: 1793–1800.PubMedCrossRefGoogle Scholar
  19. 19.
    O‘Keefe GE, Gentilello LM, Maier RV: Incidence of infectious complications associated with the use of histamine2-receptor antagonists in critically ill trauma patients. Ann Surg 1998; 227: 120–125.PubMedCrossRefGoogle Scholar
  20. 20.
    Braga M, Gianotti L, Vignali A, et al: Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet. Crit Care Med 1998; 260: 24–30.CrossRefGoogle Scholar
  21. 21.
    Bryg DJ, Beale RJ: Clinical effects of enteral immunonutrition on intensive care patients: a meta-analysis. Crit Care Med 1998; 26: A91.CrossRefGoogle Scholar
  22. 22.
    Ljubanovic M, Calvin J, Peruzzi W: Meta-analysis of gastric pH as determinant of mortality in critically ill patients. Crit Care Med 1998; 26: A123.CrossRefGoogle Scholar
  23. 23.
    Kirton O, Civetta J, Hudson-Civetta J, et al: Gastric intra-mucosal pH (pHi) driven resuscitation and anti-oxidants: normalized pHi is associated with high survival. Crit Care Med 1998; 26: A142.CrossRefGoogle Scholar
  24. 24.
    Ivatury RR, Simon RJ, Islam S, et al: A prospective randomized study of end points of resuscitation after major trauma. J Am Coll Surg 1996; 183: 145–154.PubMedGoogle Scholar
  25. 25.
    Vandenbroueke-Grauls CMJ, Vandenbroucke JP: Effect of selective decontamination of the digestive tract on respiratory infections and mortality in the intensive care unit. Lancet 1991; 338: 859–862.CrossRefGoogle Scholar
  26. 26.
    Lingnau W, Berger J, Javorsy F, et al: Selective intestinal decontamination in multiple trauma patients: prospective controlled trial. J Trauma 1997; 42: 687–694.PubMedCrossRefGoogle Scholar
  27. 27.
    Sun X, Wagner DP, Knaus WA: Does selective decontamination of the digestive tract reduce mortality for severely ill patients? Crit Care Med 1996; 24: 753–755.PubMedCrossRefGoogle Scholar
  28. 28.
    Luiten EJ, Hop WCJ, Lange JE, Bruining HA: Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg 1995; 222: 57–65.PubMedCrossRefGoogle Scholar
  29. 29.
    Baxby D, van Saene HKF, Stoutenbeek CP, Zandstra DF: Selective decontamination of the digestive tract: 13 years on, what it is and whatit is not. Intensive Care Med 1996; 22: 699–706.PubMedCrossRefGoogle Scholar
  30. 30.
    Dellinger RP, Zimmerman JL, Taylor RW, et al: Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Crit Care Med 1998; 26: 15–23.PubMedCrossRefGoogle Scholar
  31. 31.
    Johannigman JA, Davis K Jr, Campbell RS, et al: Inhaled nitric oxide in acute respiratory distress syndrome. J Trauma 1997; 43: 904–910.PubMedCrossRefGoogle Scholar
  32. 32.
    Matthay MA, Pittet JF, Jayr C: Just say NO to inhaled nitric oxide for the acute respiratory distress syndrome. Crit Care Med 1998; 26: 1–2.PubMedCrossRefGoogle Scholar
  33. 33.
    Zapol WM: Nitrix oxide inhalation in acute respiratory distress syndrome: it works, but can we prove it? Crit Care Med 1998; 26: 2–3.PubMedCrossRefGoogle Scholar
  34. 34.
    Moore FA, Haenel JB, Moore EE, Whitehill TA: Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure. J Trauma 1992; 33: 58–66.PubMedCrossRefGoogle Scholar
  35. 35.
    Durham RM, Neunaber K, Mazuski JE, et al: The use of oxygen consumption and delivery as endpoints for resuscitation in critically ill patients. J Trauma 1996; 41: 32–40.PubMedCrossRefGoogle Scholar
  36. 36.
    Shoemaker WC, Appel PL, Kram HB, et al: Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988; 94: 1176–1188.PubMedCrossRefGoogle Scholar
  37. 37.
    Gattinoni L, Brazzi L, Pelosi P, et al: A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 1995; 333: 1025–1032.PubMedCrossRefGoogle Scholar
  38. 38.
    Moore EE: Hypertonic saline dextran for post-injury resuscitation: experimental background and clinical experience. Aust NZ J Surg 1991; 61: 732–736.Google Scholar
  39. 39.
    Vassar JJ, Perry CA, Gannaway WL, Holcroft JW: 7.5% Sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Arch Surg 1991; 126: 1065–1072.PubMedCrossRefGoogle Scholar
  40. 40.
    Wade CE, Kramer GC, Grady JJ, et al: Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies. Surgery 1997; 122: 609–616.PubMedCrossRefGoogle Scholar
  41. 41.
    Younes RN, Yin KC, Amino CJ, et al: Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room. World J Surg 1998; 22: 2–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Shackford SR, Bourguignon PR, Wald SL, et al: Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. J Trauma 1998; 44: 50–58.PubMedCrossRefGoogle Scholar
  43. 43.
    Robinson DA, Wang P, Chaudry IH: Pentoxifylline restores the depressed cardiac performance after trauma-hemorrhage and resuscitation. J Surg Res 1996; 66: 51–56.PubMedCrossRefGoogle Scholar
  44. 44.
    Staubach K-H, Schroder J, Stuber, et al: Effect of pentoxiflline in severe sepsis. Arch Ital Surg 1998; 133: 94–100.CrossRefGoogle Scholar
  45. 45.
    Bacher A, Mayer N, Klimscha W, et al: Effects of pentoxifylline on hemodynamics and oxygenation in septic and nonseptic patients. Crit Care Med 1997; 25: 795–800.PubMedCrossRefGoogle Scholar
  46. 46.
    Kolla S, Awad SS, Rich PB, et al: Extracorporeal life support for 100 adult patients with severe respiratory failure. Ann Surg 1997; 226: 544–566.PubMedCrossRefGoogle Scholar
  47. 47.
    Peek GJ, Moore HM, Moore N, et al: Extracorporeal membrane oxygenation for adult respiratory failure. Chest 1997; 112: 759–764.PubMedCrossRefGoogle Scholar
  48. 48.
    Meldrurm DR, Moore FA, Moore EE, et al: Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997; 174: 667–673.CrossRefGoogle Scholar
  49. 49.
    Moore EE: Staged laparotomy for the hypothermia, acidosis and coagulopathy syndrome. Am J Surg 1996; 172: 405–410.PubMedCrossRefGoogle Scholar
  50. 50.
    Stiletto R, Bruck E, Bittner G: Low cost prone positioning of critically ill ARDS patients with MPS (modular prone positioning system). Crit Care 1998; 2: 59.CrossRefGoogle Scholar
  51. 51.
    Raguin O, Rusterholtz T, Berton C, et al: Use of a clinical protocol to assess the respective indications of prone position and nitric oxide in patients with ARDS. Crit Care 1998; 2: 58.CrossRefGoogle Scholar
  52. 52.
    Stiletto RJ, Bruck E, Ziering E, Goteen L: Hie role of positioning in the prevention of ALI and ARDS in polytrauma patients. Crit Care 1998; 2: 58.CrossRefGoogle Scholar
  53. 53.
    Abraham E, Yoshihara G: Cardiorespiratory effects of pressure controlled inverse ratio ventilation in severe respiratory failure. Chest 1989; 96: 1356–1359.PubMedCrossRefGoogle Scholar
  54. 54.
    Poelart JI, Visser CA, Everaert JA: Acute hemodynamic changes of pressure controlled inverse ratio ventilation in the adult respiratory distress syndrome. Chest 1993; 104: 214–219.CrossRefGoogle Scholar
  55. 55.
    Schmidt GA, Wood LDH: Critical care medicine. JAMA 1993; 270: 192–196.CrossRefGoogle Scholar
  56. 56.
    Hirasawa H, Sugai T, Oda S, et al: Continuous hemodiafiltration (CHDF) removes cytokines and improves respiratory index (RI) and oxygen metabolism in patients with acute respiratory distress syndrome (ARDS). Crit Care Med 1998; 26: A120.CrossRefGoogle Scholar
  57. 57.
    Honore PM, James J, Wauthier M, Dugernier T: Reversal of intractable circulatory failure complicating septic shock with shock with short time high volume haemoffltration (ST-HV-CVVH) after failure of conventional therapy: a prospective evaluation. Crit Gare 1998; 2: 62.Google Scholar
  58. 58.
    Thangathurai D, Oharbomnet C, Wo CCJ, et al: Intraoperative maintenance of tissue perfusion prevents ARDS. New Horii 1996; 4: 466–474.Google Scholar
  59. 59.
    Heslin MJ, Latkany L, Leung D, et al: A prospective, randomized trial of early enteral feeding after resection of upper GI malignancy. Ann Surg (in press)Google Scholar
  60. 60.
    Watters JM, Kirkpatrick SM, Norris SB, et al: Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility. Ann Surg 1997; 226: 369–380.PubMedCrossRefGoogle Scholar
  61. 61.
    Mathisen DJ, Kuo EY, Hahn C, et al: Inhaled nitric oxide for adult respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 1998; 65: 1894–1982.CrossRefGoogle Scholar
  62. 62.
    Gentielelo LM, Jurkovich GJ, Stark MS, et al: Is hypothermia in the victim of major trauma protective or harmful? Ann Surg 1997; 226: 439–449.CrossRefGoogle Scholar
  63. 63.
    Kurz A, Sessler DI, Lenhardt R: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334: 1209–1215.PubMedCrossRefGoogle Scholar
  64. 64.
    Friedman G, Silva E, Vincent JL: Has the mortality of septic shock changed with time? Crit Care Med 1998; 23: 2078–2086.CrossRefGoogle Scholar
  65. 65.
    Cohen NH: Reduced mortality from septic shock: lessons for the future. Crit Care Med 1998; 26: 1956–1958.PubMedCrossRefGoogle Scholar
  66. 66.
    Stehben WE: Causality in medical science with particular reference to heart disease and arteriosclerosis. Perspect Biol Med 1993; 36: 97–119.Google Scholar
  67. 67.
    Levine JH, Durham RM, Moran J, Baue A: Multiple organ failure: is it disappearing? World J Surg 1996; 20: 471–473.PubMedCrossRefGoogle Scholar
  68. 68.
    Knaus W, Draper E, Wapier D, Zimmerman J: Prognosis in acute organ-system failure. Ann Surg 1985; 202: 685–693.PubMedCrossRefGoogle Scholar
  69. 69.
    Petros A, Van Saene R: Is reduction in mortality in intensive care just another Holy Grail? In: Gullo A (ed) Critical Care Medicine A.P.I.C.E. 12. Milan, Springer, 1998; 495–498.Google Scholar

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© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Arthur E. Baue

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