Sepsis, Disseminated Intravascular Coagulation and Multiorgan Failure: Catastrophic Events in Severe Burns

  • H. A. Linares
Conference paper

Abstract

A thermal burn is essentially an inflammatory process which, if severe enough, can elicite not only local damage but a wide spectrum of systemic manifestations accompanied by life-threatening complications.

Keywords

Permeability Depression Ischemia Superoxide Bacillus 

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References

  1. Ahren C, Haglund V (1973) Mucosal lesions in the small intestine of the cat during low flow. Acta Physiol Scand 88: 541–550PubMedGoogle Scholar
  2. Aikawa N, Shinozawa Y, Ishibiki K, Abe O (1987) Clinical analysis of multiple organ failure in burned patients, Burns 13: 103–109Google Scholar
  3. Alkjaersig N, Fletcher AP, Peden JC, Monafo WW (1980) Fibrinogen catabolism in burned patients. J Trauma 20: 154–159PubMedGoogle Scholar
  4. Argamaso RV (1967) Pathology, mortality and prognosis of burns. Can Med Assoc J 97: 445–449PubMedGoogle Scholar
  5. Arnold L (1929) Alterations in the endogenous enteric bacterial flora and microbic permeability of the intestinal wall in relation to the nutritional and meterological changes. J Hyp 29: 82–116Google Scholar
  6. Arturson G (in press) The physiopathological derangement of burns. In: Bendlin A, Linares HA, Benaim F (eds) Treatise on burns, McGraw-Hill, New York MexicoGoogle Scholar
  7. Baker JW, Deitch EA, Berg RD, Specian RD (1988) Hemorrhagic shock induces bacterial translocation from the gut. J Trauma 28: 896–906PubMedGoogle Scholar
  8. Bartlett RH, Fong SW, Marrujo G, Hardeman J, Anderson W (1980) Coagulation and platelet changes after thermal injury in man. Burns 7: 370–377Google Scholar
  9. Baue AE (1975) Multiple, progressive, or sequential systems failure: a syndrome of the 1970s. Arch Surg 110: 779–781PubMedGoogle Scholar
  10. Berg RD (1983) Translocationof indigenous bacteria from the intestinal tract. In: Hentges DJ (ed) Human intestinal microflora in health and diseases, Academic press Inc., Orlando, Fla, p 333Google Scholar
  11. Berg RD, Garlington AW (1979) Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model. Infect Immun 23: 403–411PubMedGoogle Scholar
  12. Berg RD, Wommack E, Deitch EA (1988) Immunosuppression and intestinal bacterial overgrowth synergistically promote bacterial translocation. Arch Surg 123: 1359–1364PubMedGoogle Scholar
  13. Berringer R, Harwood-Nuss AL (1985) Septic shock. J Emerg Med 3: 475–483PubMedGoogle Scholar
  14. Bick RL (1988) Disseminated intravascular coagulation and related syndromes: a clinical review. Sem Thromb Hemost 14: 299–337Google Scholar
  15. Blaisdell FW (1973) Respiratory insufficiency syndrome: clinical and pathological definition. J Trauma 13: 195–199PubMedGoogle Scholar
  16. Bounous G, Menard D, DeMedicis E (1977) Role of pancreatic proteases in the pathogenesis of ischemic enteropathy. Gastroenterology 73: 102–108PubMedGoogle Scholar
  17. Border JR (1988) Hypothesis: sepsis, multiple systems organ failure, and the macrophage. Arch Surg 123: 285–286PubMedGoogle Scholar
  18. Boyer JL (1983) Tight junctions in normal and cholestatic liver. Does the paracellular pathway have functional significance? Hepatology 3: 614–617PubMedGoogle Scholar
  19. Cano N, Gerolami A (1983) Intrahepatic cholestasis during total parenteral nutrition. Lancet 1: 985PubMedGoogle Scholar
  20. Carmona R, Catalano R, Trunkey DD (1984) Septic shock. In: Shires GT (ed) Shock and related problems, Churchill Livingstone, Edinburg, p 156Google Scholar
  21. Clowes GHA, Zuschneid W, Dragacevic S, Turner M (1968) The nonspecific pul-monary inflammatory reactions leading to respiratory failure after shock, gangrene and sepsis. J Trauma 8: 899–914PubMedGoogle Scholar
  22. Cotran RS, Kumar V, Robbins SL (1989) Robbins pathologic basis of disease. W B Saunders, Philadelphia, p 116Google Scholar
  23. Craddock PR, Fehr J, Dalmasso AP, Brigham KL, Jacob HS (1977) Pulmonary leukostasis resulting from complement activation of dialyzer cellophane membranes. J Clin Invest 59: 879–888PubMedGoogle Scholar
  24. Craddock PR, Hammerschmidt DE, Moldow CF, Yamada O, Jacob HS (1979) Granulocyte aggregation as a manifestation of membrane interactions with complement: possible role in leukocyte margination, microvascular occlusion, and endothelial damage. Semin Hematol 16: 140–147PubMedGoogle Scholar
  25. Cumin W (1823) Cases of severe burn with dissections, and remarks. Edinburgh Med Surg J 19: 337–344Google Scholar
  26. Curreri PW, Katz AF, Dotin LN, Pruitt BA (1970) Coagulation abnormalities in the thermally injured patient. In: Skinner DB, Ebert PA (eds) Current topics in surgical research, vol 2. Academic Press, New York London, p 401Google Scholar
  27. DeCamp MM, Demling RH (1988) Posttraumatic multisystem organ failure. JAMA 260: 530–534PubMedGoogle Scholar
  28. Deitch EA, Berg R (1987) Bacterial translocation from the gut: a mechanism of infection. JBCR 8: 475–482Google Scholar
  29. Deitch EA, Ma L, Ma JW, Berg RD (1989b) Lethal burn-induced bacterial translocation: role of genetic resistance. J Trauma 29: 1480–1487PubMedGoogle Scholar
  30. Deitch EA, Maejima K, Berg R (1985) Effect of oral antibiotics and bacterial overgrowth on the translocation of the GI tract microflora in burned rats. J Trauma 25: 385–392PubMedGoogle Scholar
  31. Deitch EA, Taylor M., Grisham M, Ma L, Bridges W, Berg R (1989a) Endotoxin induces bacterial translocation and increases xanthine oxidase activity. J Trauma 29: 1679–1683PubMedGoogle Scholar
  32. Delarue J (1962) Les lesions viscerales des grands brules. Ann Anat Pathol 7: 53–85Google Scholar
  33. Demling RH (1987a) Fluid replacement in burned patients. Surg Clin North Am 67: 15–30PubMedGoogle Scholar
  34. Demling RH (1987b) Wound inflammatory mediators and multisystem organ failure. Progr Clin Biol Res 236A: 523–537Google Scholar
  35. Demling RH, Wilson RF (1988) Decision making in surgical critical care. B.C. Decker, Inc., Toronto, p 172Google Scholar
  36. Demling RH, Wong C, Jin LJ, Hechtman H, Lalonde C., West K (1985) Early lung dysfunction after major burns: role of edema and vasoactive mediators. J Trauma 25: 959–966PubMedGoogle Scholar
  37. Dupuytren G (1839) Lecons orales de clinique chirurgicale: XII. Des brulures. In: Gailliere G (ed), vol 4. ParisGoogle Scholar
  38. Effeney DJ, Blaisdell FW, McIntyre KE, Graziano CJ (1978) The relationship between sepsis and disseminated intravascular coagulation. J Trauma 18: 689–695PubMedGoogle Scholar
  39. Elias E, Hruban H, Wade J, Boyer JL (1980) Phalloidin-induced cholestasis: a microfilament-mediated change in junctional complex permeability. Proc Natl Acad Sci 77: 2229–2233PubMedGoogle Scholar
  40. Erlinger S (1978) Cholestasis: pump failure, microvilli defect or both? Lancet 1: 533–534PubMedGoogle Scholar
  41. Eurenius K, Rossi TD, McEuen D, Arnold J., McManus WF (1974) Blood coagulation in burn injury (38460). Proc Soc Exp Biol Med 147: 878–882PubMedGoogle Scholar
  42. Fishman AP (1973) Shock lung: a distinctive nomentity Circulation 47: 921–929PubMedGoogle Scholar
  43. Ford WW (1901) On the bacteriology of normal organs. J Hgy 1: 277–284Google Scholar
  44. Franson TR, Hierholzer WJ, LaBrecque DR (1985) Frequency and characteristics of hyperbilirubinemia associated with bacteremia. Rev Infec Dis 7: 1–9Google Scholar
  45. Fredholm B, Hagermark O (1970) Studies on histamine release from skin and from peritoneal mast cells of the rat induced by heat. Acta Derm Venereol (Stockh) 50: 273–277Google Scholar
  46. Fry DE, Pearlstein L, Fulton RL, Polk HC (1980) Multiple system organ failure. Arch Surg 115: 136–140PubMedGoogle Scholar
  47. Goris RJA, Boekhorst TPA, Nuytinck JKS, Gimbrere JSF (1985) Multiple-organ failure: generalized autodestructive inflammation? Arch Surg 120: 1109–1115.PubMedGoogle Scholar
  48. Graf J, Peterlik L (1975) Mechanism of transport of inorganic ions into bile. In: Taylor W (ed) The hepatobiliary system: fundamental pathological mechanisms, Plenum Press, New York, p 43Google Scholar
  49. Hamilton PJ, Stalker AL, Douglas AS (1978) Disseminated intravascular coagulation: a review. J Clin Path 31: 609–619PubMedGoogle Scholar
  50. Hardaway RM, McKay DG (1963) The syndromes of disseminated intravascular coagulation. Review Surg 20: 297–328Google Scholar
  51. Hechtman HB, Valeri CR, Shepro D (1984) Role of humoral mediators in adult respiratory distress syndrome. Chest 86: 623–627PubMedGoogle Scholar
  52. Henson PM, McCarthy K, Larsen GL, et al (1981) Complement fragments, alveolar macrophages, and alveolitis. Am J Pathol 97: 93–110Google Scholar
  53. Horakova Z, Beaven MA (1974) Time course of histamine release and edema formation in the rat paw after thermal injury. Eur J Pharmacol 27: 305–312PubMedGoogle Scholar
  54. Hosea S, Brown E, Hammer C, Frank M (1980) Role of complement activation in a model of adult respiratory distress syndrome. J Clin Invest 66: 375–382PubMedGoogle Scholar
  55. Hurd T, Lysz T, Dikdan G, McGee J, Rush BF, Machiedo GW (1988) Hepatic cellular dysfunction in sepsis: an ischemic phenomenon? Curr Surg 45: 114–119PubMedGoogle Scholar
  56. Hyers TM (1981) Pathogenesis of adult respiratory distress syndrome: current concepts. Semin Respir Med 2: 104–108Google Scholar
  57. Inoue S, Wirman JA, Alexander JW, Trocki O, Cardeil RR (1988) Candida albicans translocation across the gut mucosa following burn injury. J Surg Res 44: 479–492PubMedGoogle Scholar
  58. Jacob HS, Craddock PR, Hammerschmidt DE, Moldow CF (1980) Complement-induced granulocyte aggregation: an unsuspected mechanisms of disease. N Engl J Med 302: 789–794PubMedGoogle Scholar
  59. Kakis G, Yousef IM (1978) Pathogenesis of lithocholate and tauro- lithocholate-induced intrahepatic cholestasis in rats. Gastro-enterology 75: 595–607Google Scholar
  60. Karyoute SM, Badran DH (1989) Analysis of 100 patients with thermal injury treated in a new burn unit in Amman, Jordan. Burns 15: 23–26Google Scholar
  61. Linares HA (1982) A report of 115 consecutive autopsies in burned children: 1966–1980. Burns 8: 263–270Google Scholar
  62. Linares HA (1988) Autopsy findings in burned children. In: Carvajal HF, Parks DH (eds) Burns in children: Pediatric burn management, Year Book Medical Publishers, Chicago, pp 287–302Google Scholar
  63. Long J (1840) Post-mortem appearances found after burns. London Med Gazette 25: 743–750Google Scholar
  64. Ma L, Ma J, Deitch EA, Specian RD, Berg RD (1989) Genetic susceptibility to mucosal damage leads to bacterial translocation in a murine burn model. J Trauma 29: 1245–1251PubMedGoogle Scholar
  65. Maejima K, Deitch EA, Berg RD (1984) Bacterial translocation from the gastrointestinal tracts of rats receiving thermal injury. Infec Immun 43: 6–10Google Scholar
  66. Marshall J, Sweeney D (1990) Microbial infection and the septic response in critical surgical illness. Arch Surg 125: 17–23PubMedGoogle Scholar
  67. McManus WF, Eurenius K, Pruitt BA (1973) Disseminated intravascular coagulation in burned patients. J Trauma 13: 416–422PubMedGoogle Scholar
  68. Meakins JL, Wicklund B, Forse RA, McLean AP (1980) The surgical intensive care unit: current concepts in infection. Surg Clin North Am 60: 117–132PubMedGoogle Scholar
  69. Mohan N, Leslie K, Sandor G, Douglas LG, Peters WJ (1988) Multisystem organ failure in burn patients. Canadian Trauma Association Meeting, September 23–24, OtawaGoogle Scholar
  70. Neame PB, Lechago J, Ling ET, Koval A (1973) Thrombotic thrombocytopenic purpura: Report of a case with disseminated intravascular platelet aggregation. Blood 42: 807–814Google Scholar
  71. Neely AN, Nathan P, Highsmith RF (1988) Plasma proteolytic activity following burns. J Trauma 28: 362–367PubMedGoogle Scholar
  72. Nuytinck HKS, Offermans XJM, Kubat K, Goris JA (1988) Whole-body inflammation in trauma patients. Arch Surg 123: 1519–1524PubMedGoogle Scholar
  73. Ognibene FP, Martin SE, Parker MM, Schlesinger T, Roach P, Burch C, Shelhamer JH, Parrillo JE (1986) Adult respiratory distress syndrome in patients with severe neutropenia. New Eng J Med 315: 547–551PubMedGoogle Scholar
  74. Olsson P (1969) Clinical views on the kinin system. Scand J Clin Lab Invest (suppl) 24: 123–124Google Scholar
  75. Orth J (1908) What is the cause of death? Berlin Klin Wochenschr 45: 485–490Google Scholar
  76. Pardy BJ, Dudley HAF (1977) Post-traumatic pulmonary insufficiency. Surg. Gynec Obstet 144: 259–269PubMedGoogle Scholar
  77. Parks DA, Bulkley GB, Granger DN, Hamilton SR, McCord JM (1982) Ischemic injury in the cat small intestine: role of superoxide radicals. Gastroenterology 82: 9–15PubMedGoogle Scholar
  78. Petroff P, Pruitt BA (1979) Pulmonary disease in the burn patient. In: Artz C, Moncrief W, Pruitt B (eds) Burns, a team approach, Saunders, Philadelphia, p 95Google Scholar
  79. Phillips MJ (1980) Mechanisms of cholestasis: a selected review. Gastro- enterology Jpn 15: 415–421Google Scholar
  80. Phillips MJ, Oda MME, Fisher MM, Jeejeebhoy KN (1975) Microfilament dysfunction as a possible cause of intrahepatic cholestasis. Gastro- enterology 69: 48–58Google Scholar
  81. Phillips MJ, Poucell S (1987) Cholestasis: surgical pathology, mechanisms, and new concepts. In: Farber E, Phillips MJ, Kaufman N (eds) Pathogenesis of liver diseases, Williams and Wilkins, Baltimore, pp 65–94Google Scholar
  82. Popiel I, Turnbull PCB (1985) Passage of salmonella enteritidis and salmonella thompson through chick ileocecal mucosa. Infec Immun 47: 786–792Google Scholar
  83. Redl H, Hallstrom S, Lieners C, Furst W, Schag G (1988) Proteolysis and lipid peroxidation. Two aspects of cell injury in experimental hypovolemic-traumatic shock. Adv Exp Med Biol 240: 449–455PubMedGoogle Scholar
  84. Reichen J, Simon FR (1984) Mechanisms of cholestasis. Int Rev Exp Pathol 26: 232–273Google Scholar
  85. Schirmer WJ, Schirmer JM, Naff GB, Fry DE (1988) Systemic complement activation produces hemodynamic changes characteristic of sepsis. Arch Surg 123: 316–321PubMedGoogle Scholar
  86. Schlag G, Redl H (1989) Lung in shock — posttraumatic lung failure (organ failure) — MOFS. Prog Clin Biol Res 308: 3–16PubMedGoogle Scholar
  87. Sevitt S (1972) Reflections on mortality and causes of death after injury and burns. Injury 4: 151–156PubMedGoogle Scholar
  88. Sevitt S (1974) Reactions to injury and burns and their clinical importance. William Heinemann Medical Books, London, p 175Google Scholar
  89. Sprague RS, Stephenson AH, Dahns TE, Lonigro AJ (1989) Proposed role for leukotrienes in the pathophysiology of multiple systems organ failure. Crit Care Clinics 5: 315–329Google Scholar
  90. Swank DW, Moore SB (1989) Roles of the neutrophil and other mediators in adult respiratory distress syndrome. Mayo Clin Proc 64: 1118–1132PubMedGoogle Scholar
  91. Takeuchi A (1967) Electron microscope studies of experimental salmonella infection. Amer J Path 50: 109–136PubMedGoogle Scholar
  92. Teplitz C (1979) The pathology of burns and the fundamental of burn wound sepsis. In: Artz CL, Moncrief, JA, Pruitt BA (eds) Burns: a team approach, W B Saunders, Philadelphia, p 45Google Scholar
  93. Teplitz C, Davis D, Mason AD, Moncrief JA (1964) Pseudomonas burn wound sepsis. 1.Pathogenesis of experimental Pseudomonas burn wound sepsis. J Surg Res 4: 200–222PubMedGoogle Scholar
  94. Vedder NB, Winn RK, Rice CL, Harlan JM (1989) Neutrophil-mediated vascular injury in shock and multiple organ failure. Prog Clin Biol Res 299: 181–191PubMedGoogle Scholar
  95. Wagner BM (1989) A new look at the endothelial cell. Modern Path 2: 186Google Scholar
  96. Wartman WB (1962) Mechanisms of death in severe burn injury: The need for planned autopsies. In: Artz CP (ed) Research in burns, FA Davis, Philadelphia, p 6.Google Scholar
  97. Watanabe T, Imamura T, Nakagaki K, Tanaka K (1979) Disseminated intravascular coagulation in autopsy cases: its incidence and clinico-pathologic significance. Path Res Pract 165: 311–322PubMedGoogle Scholar
  98. Wells CL, Maddaus MA, Simmons RL (1988) Proposed mechanisms for the translocation of intestinal bacteria. Rev Infec Dis 10: 958–979Google Scholar
  99. Wiles JB, Cerra FB, Siegel JH, Border JR (1980) The systemic septic response: does the organism matter? Crit Care Med 8: 55–60PubMedGoogle Scholar
  100. Wolochow H, Hildebrand GJ, Lamanna C (1966) Translocation of microorganisms across the intestinal wall of the rat: effects of microbial size and concentration. J Infect Dis 116: 523–528PubMedGoogle Scholar
  101. Yi-sheng G, Ngao L, Jing-guan S, Yuan-ping L, Davies JWL (1985) Histopathological and ultrastructural changes in liver tissue from burned patients. Burns 11: 408–418Google Scholar
  102. Zimmerman TJ, Krizek TJ (1984) Thermally induced dermal injury: a review of pathophysiologic events and therapeutic intervention. JBCR 5: 193–201Google Scholar

Copyright information

© Springer-Verlag Berlin, Heidelberg 1991

Authors and Affiliations

  • H. A. Linares
    • 1
  1. 1.Shriners Burns Institute and The University of Texas Medical BranchGalvestonUSA

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