Liver-Lung Interactions in Critical Illness

  • G. M. Matuschak
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 23)

Abstract

Though acknowledged to have a central role in host defense homeostasis as well as immunological, biochemical, and metabolic regulation, the liver has not been recognized as pivotal to outcome in the acute respiratory distress syndrome (ARDS) for several reasons. Patients with liver disease have often been excluded from study, and hepatic dysfunction has often been nonspecifically defined by “liver function tests” [1]. The liver is not as accessible for study as the lung and other organs, and acute liver dysfunction is not as immediately evident as is acute lung injury [2, 3]. We have proposed an expanded conception of sepsis- and trauma-related ARDS as the central pulmonary manifestation of a generalized disorder of immunoregulation; the pathogenesis and resolution of lung injury are linked to more fundamental derangements in systemic host defense [2–8]. This reorientation implies that understanding the pathways by which changes in hepatic performance affect pulmonary function in ARDS may have therapeutic utility. Here we examine the thesis that hepatic performance modulated predisposition and resolution of lung injury in ARDS by affecting four interrelated elements of host defense: (a) control of systemic endotoxemia, bacteremia, and vasoactive byproducts of sepsis and trauma, (b) regulation of the production and export of endogenous inflammatory mediators by mononuclear phagocytes (Kupffer cells), (c) metabolic inactivation and detoxification of these mediators, and (d) synthesis of acute-phase proteins essential in intermediary metabolism and control of the inflammatory response. As a corollary, we assess clinical and experimental evidence suggesting that alterations in hepatic performance augment lung inflammation and mortality owing to a cytokine:eicosanoid axis of inflammation within the intravascular compartment and lower respiratory tract.

Keywords

Hepatitis Ischemia Dopamine Cortisol Adenosine 

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© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • G. M. Matuschak

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