Liver-Lung Interactions in ARDS with MOF

  • G. M. Matuschak
  • A. J. Lechner
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 1993 book series (YEARBOOK, volume 1993)


Multiple organ failure is a complex process occurring in up to 15% of patients in the intensive care unit (ICU) after initially successful resuscitation from severe infection, generalized activation of acute inflammatory responses (e. g. acute pancreatitis), or trauma [1–4]. Recently, this process has been termed the multiple organ dysfunction Syndrome (MODS), in view of the difficulties in distinguishing organ dysfunction from “failure” [1–3]. Despite application of progressively sophisticated diagnostic techniques and supportive care, the incidence of MODS is rising. More patients are elderly and immunocompromised, and undergo increasingly invasive procedures or therapeutic immunosuppression [1]. Case-specific mortality rates still ränge from 60–100% depending on patient age, pre-existing health status, number of organ systems involved, and the duration of organ impairment [3, 4]. Numerical aspects of organ dysfunction during MODS are strongly associated with mortality, independent of individual organ Performance [4]. However, the attendant notion of “organ equivalence” is no longer tenable with respect to their susceptibility to injury, involvement in systemic host defense regulation, and role in inducing cellular injury in remote organ systems owing to inappropriately regulated host responses.


Systemic Inflammatory Response Syndrome Kupffer Cell Multiple Organ Dysfunction Syndrome Adult Respiratory Distress Syndrome Acute Inflammatory Response 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bone RC, Fein AM, Balk RA, et al. (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101: 1644–1655.PubMedCrossRefGoogle Scholar
  2. 2.
    Matuschak GM, Rinaldo JE (1988) Organ system interactions in the adult respiratory distress Syndrome: role of the liver in host defense. Chest 94: 400–408PubMedCrossRefGoogle Scholar
  3. 3.
    Bone RC (1991) The pathogenesis of sepsis. Ann Intern Med 115: 457–469PubMedGoogle Scholar
  4. 4.
    Matuschak GM (1992) Multiple systems organ failure: Clinical expression, pathogenesis, and therapy. In: Hall JB, Schmidt GA, Wood LDH (eds) Principles of Critical Care, McGraw-Hill, New York, pp 613–636Google Scholar
  5. 5.
    Fong Y, Marano MA, Moldawer LL, et al. (1990) The acute splanchnic and peripheral tissue metabolic response to endotoxin in humans. J Clin invest 85: 1896–1904PubMedCrossRefGoogle Scholar
  6. 6.
    Chensue SW, Terebuh PD, Remick DG, Scales WE, Kunkel SL (1991) In vivo biologic and immunohistochemical analysis of interleukin-1 alpha, beta and tumor necrosis factor during expe-rimental endotoxemia: Kinetics, Kupffer cell expression, and glucocorticoid effects. Am J Pathol 138: 395–402PubMedGoogle Scholar
  7. 7.
    Munoz C, Carlet J, Fitting C, Misset B, Bleriot J-P, Cavaillon J-M (1991) Dysregulation of in vitro cytokine production by monocytes during sepsis. J Clia Invest 88. 1747–1754CrossRefGoogle Scholar
  8. 8.
    Spinas GA, Keller U, Brockhaus M (1992) Release of soluble receptors for tumor necrosis factor ( TNF) in relation to circulating TNF during experimental endotoxemia. J Clin Invest 90: 533–536PubMedCrossRefGoogle Scholar
  9. 9.
    Bernard GR, Korley V, Chee P, Swindell B, Ford-Hutchinson AW, Tagari P (1991) Persistent generation of peptido leukotrienes in patients with the adult respiratory distress Syndrome. Am Rev Respir Dis 144: 263–267PubMedCrossRefGoogle Scholar
  10. 10.
    Nathan C (1992) Nitric oxide as a secretory product of mammalian cells. FASEB J 6: 3051–3064PubMedGoogle Scholar
  11. 11.
    Wright SD, Ramos RA, Patel M, Miller DS (1992) Septin: a factor in plasma that opsonizes lipopolysaccharide-bearing particles for recognition by CD 14 on phagocytes. J Exp Med 176: 719–727PubMedCrossRefGoogle Scholar
  12. 12.
    Kelley J (1990) Cytokines of the lung. Am Rev Respir Dis 141: 765–788PubMedCrossRefGoogle Scholar
  13. 13.
    Lechner AJ, Tredway TL, Brink DS, Klein CA, Matusehak GM (1992) Differential systemic and intrapulmonary TNFa production in Candida sepsis during immunosuppression. Am J Physiol 263 (Lung Cell Mol Physiol 7 ): (In press)Google Scholar
  14. 14.
    Colletti LM, Remick DG, Burtch GD, Kunkel SL, Strieter RM, Campbell DA Jr (1990) Role of tumor necrosis faetoroc in the pathophysiologic alterations after hepatic ischemia/reperfusion injury in the rat. J Clin Invest 85: 1936–1943PubMedCrossRefGoogle Scholar
  15. 15.
    Walsh D, Lechner AJ, Tredway TL, Niesman I, Matusehak GM (1992) Graded ischemia-reperfusion inhibits Escherichia coli-induced tumor necrosis factor production in isoltated perfused rat liver. Am Rev Respir Dis 145: A318Google Scholar
  16. 16.
    Poggetti RS, Moore FA, Moore EE, et al. (1992) Liver injury is a reversible neutrophil-mediated event following gut ischemia. Arch Surg 127: 175–179PubMedCrossRefGoogle Scholar
  17. 17.
    Matusehak GM, Pinsky MR, Klein EC, Van Thiel DH, Rinaldo JE (1990) Effects of D-galactosamine-induced acute liver injury on mortality and pulmonary responses to Escherichia coli lipopolysaccharide: Modulation by arachidonic acid metabolites. Am Rev Respir Dis 141: 1296–1306Google Scholar
  18. 18.
    Decamp MM, Warner AE, Molina RM, Brain JD (1992) Hepatic versus pulmonary uptake of particles injected into the portal circulation in sheep: Endotoxin escapes hepatic clearance causing pulmonary inflammation. Am Rev Respir Dis 146: 224–231PubMedGoogle Scholar
  19. 19.
    Loegering D (1993) Kupffer cell immune receptor modulation of susceptibility to endotoxemia and bacterial infection. In: Matusehak GM (ed) Multiple system organ failure: Hepatic regulation of systemic host defense. Marcel-Dekker, New York (In press)Google Scholar
  20. 20.
    Matusehak GM, Walsh D, Schilly DR, Tredway TL, Lechner AJ (1991) Hepatic challenge with viable E. coli vs C. albicans: Relations among phagocytosis, O2 consumption, and tumor necrosis factor-a production during ex situ isolated rat liver perfusion. Am Rev Respir Dis 143: A682Google Scholar
  21. 21.
    Matsumoto K, Tajima H, Hamanoue M, et al. (1992) Identification and characterization of “injuring”, an inducer of expression of the gene for hepatocyte growth factor. Proc Natl Acad Sei (USA) 89: 3800–3804CrossRefGoogle Scholar
  22. 22.
    Schlichtig R, Klions HA, Kramer DJ, Nemoto EM (1992) Hepatic dysoxia commences during O2 supply dependence. J Appl Physiol 72: 1499–1505PubMedGoogle Scholar
  23. 23.
    LaMarre J, Wollenberg GK, Gonias SL, Hayes MA (1991) Cytokine binding and clearance properties of proteinase-activated alpha2-macroglobulins. Lab Invest 65: 3–14PubMedGoogle Scholar
  24. 24.
    Heuertz RM, Piquette CA, Webster RO (1993) Rabbits with elevated serum C-reactive protein exhibit diminished neutrophil infiltration and vascular permeability in C5a-induced alveolitis. Am J Pathol (In press)Google Scholar

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© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • G. M. Matuschak
  • A. J. Lechner

There are no affiliations available

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