Zusammenfassung
Die disseminierte intravasale Gerinnung — im englischsprachigen Bereich als „disseminated intravascular coagulation“ (DIC) bezeichnet — stellt sowohl vom diagnostischen als auch vom therapeutischen Standpunkt aus betrachtet ein komplexes Geschehen dar. Zahlreiche Erkrankungen können unabhängig voneinander eine DIC auslösen, die klinischen Erscheinungsbilder sind mannigfaltig, die diagnostischen Kriterien sind nicht einheitlich definiert, und verschiedene, z. T. noch experimentelle Therapiestrategien wurden für den Patienteneinsatz propagiert. Allgemeine Therapieempfehlungen sind kaum zu erstellen, da die Morbidität und die Überlebensrate hauptsächlich von der spezifischen DIC-Ursache abhängen, und da prospektive, randomisierte Multizenterstudien zur Verifizierung von Therapieeffekten nicht vorliegen.
Die DIC ist keine eigenständige Erkrankung, sondern tritt als Folgeerscheinung oder Komplikation von schweren Grundkrankheiten auf. Eine Gerinnungsaktivierung im Rahmen dieser Grundkrankheiten induziert eine überschießende intravasale Gerinnung, die sich in verschiedener Weise manifestieren kann. Zum einen führt sie zur Bildung und Ablagerung von Fibrin, so daß in multiplen Organen Mikrothrombosen entstehen. Zum anderen tritt ein Verbrauch von Gerinnungsfaktoren auf, der auf der extensiven und persistierenden Aktivierung des Gerinnungssystems beruht. Verstärkt wird dieser Verbrauch durch eine reduzierte Lebersyntheseleistung und durch eine verkürzte Halbwertszeit der Gerinnungsfaktoren, wobei diese Verkürzung durch die Proteasenaktivierung bedingt ist. Aufgrund eines solchen Verbrauchs und der auftretenden Thrombopenie können gleichzeitig mit den Mikrothrombosen schwere Blutungskomplikationen entstehen.
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Literatur
Abraham E, Wunderink R, Silverman H, Perl TM, Nasraway S, Levy H, Bone R, Wenzel RP, Balk R, Allred R, Pennington JE, Wherry JC (1995) Efficacy and safety of monoclonal antibody to human tumor necrosis factor alpha in patients with sepsis syndrome: A randomized, controlled, double-blind, multicenter clinical trial. JAMA 273: 934–941 2. Alexander HR, Doherty GM, Venzon DJ, Merino MJ, Fraker DL, Norton JA (1992) Recombinant interleukin-1 receptor antagonist (IL-1ra) effective therapy against gram-negative sepsis in rats. Surgery 112: 188–193
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitons for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874
Anderson BO, Bensard DD, Harken AH (1991) The role of platelet activating factor and its antagonists in shock, sepsis and multiple organ failure. Surgery 172: 415–424
Bakker J, Zhang H, Depierreux M, van Asbeck S, Vincent JL (1994) Effects of N-acetylcysteine in endotoxic shock. J Crit Care 9: 236–243
Balk RA, Parrillo JE (1992) Prognostic factors in sepsis. The cold facts [editorial]. Crit Care Med 20: 1373–1374
Bardenheuer M, Obertacke U, Kleinschmidt C, Scherer R, Eisold C, Jochum M, SchmidtNeuerburg KP (1994) Prophylactic continuous application of antithrombin-III (140% serum activity for 4 days after trauma) for reduction of shock related complications and pulmonary microvascular permeability - A prospective clinical study [abstract]. Intensive Care Med 20 [Suppl 1]: S121
Barone JE, Lowenfels AB (1992) Maximization of oxygen delivery: A plea for moderation. J Trauma 33: 651–653
Battafarano RJ, Dunn DL (1992) Role of nitric oxide during sepsis [editorial]. Crit Care Med 20: 1504–1505
Baue AE (1992) The Horror autotoxicus and multiple-organ failure. Arch Surg 127: 14511462
Baumgartner JD, Büla C, Vaney C, Wu MM, Eggimann P, Perret C (1992) A novel score for predicting the mortality of septic shock patients. Crit Care Med 20: 953–960
Bellomo R, Tipping P, Boyce N (1993) Continuous veno-venous hemofiltration with dialysis removes cytokines from the circulation of septic patients. Crit Care Med 21: 522–526
Benjamin E, Leibowitz AB, Oropello J, Iberti TJ (1992) Systemic hypoxic and inflammatory syndrome: An alternative designation for „sepsis syndrome“. Crit Care Med 20: 680–682
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R, and the Consensus Committee (1994) The American-European consensus conference on ARDS: defmitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149: 818–824
Biemond BJ, Levi M, ten Cate H, Soule HR, Morris LD, Foster DL, Bogowitz CA, van der Poll T, Bailer HR, ten Cate JW (1995) Complete inhibition of endotoxin-induced coagulation activation in chimpanzees with a monoclonal Fab fragment against factor VII/VIla. Thromb Haemost 73: 223–230
Blauhut B, Kramar H, Vinazzer H, Bergmann H (1985) Substitution of antithrombin III in shock and DIC: A randomized study. Thromb Res 39: 81–89
Böhmer R, Ostendorf PC (1987) Aktueller Wissensstand zur Pathogenese and Prophylaxe der Postsplenektomiesepsis ( OPSI ). Internist 28: 777–782
Bohrer H, Schmidt H, Bach A, Böttiger BW, Motsch J, Martin E (1995) Combination treatment of sepsis with polyvalent immunoglobulins and low-dose hydrocortisone [abstract]. Crit Care Med 23: A156
Böhrer H, Zhang Y, Nawroth PP, Bach A, BSttiger BW, Schmidt H, Martin E (1995) Intravenous somatic gene transfer with antisense tissue factor reduces mortality in mice with endotoxin-induced sepsis [abstract]. Crit Care Med 23: A155
Bohrer H, Zhang Y, Qiu F, Nawroth PP, Bach A, Schmidt H, Martin E (1995) Endotoxin-induzierte Transkriptionsfaktoren vermitteln die Sepsis-Letalität im Mausmodell [abstract]. Anaesthesist 44 [Suppl 1]: S87
Bolton CF, Young GB, Zochodne DW (1993) The neurological complications of sepsis. Ann Neurol 33: 94–100
Bone RC (1992) Phospholipids and their inhibitors: A critical evaluation of their role in the treatment of sepsis. Crit Care Med 20: 884–890
Bone RC (1992) Sepsis and coagulation. An important link [editorial]. Chest 101: 594–596
Bone RC (1992) Toward an epidemiology and natural history of SIRS (systemic inflammatory response syndrome). JAMA 268: 3452–3455
Bone RC, Francis PB, Pierce AK (1976) Intravascular coagulation associated with the adult respiratory distress syndrome. Am J Med 61: 585–589
Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA, The Methylprednisolone Severe Sepsis Study Group (1987) A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 317: 653–658
Bone RC, Sprung CL, Sibbald WJ (1992) Definitions for sepsis and organ failure [editorial]. Crit Care Med 20: 724–726
Booke M, Meyer J, Lingnau W, Hinder F, Traber LD, Traber DL (1995) Use of nitric oxide synthase inhibitors in animal models of sepsis. New Horizons 3: 123–138
Bower RH, Cerra FB, Bershadsky B, Licari JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkopf MM, Daly JM, Adelsberg BR (1995) Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Crit Care Med 23: 436–449
Brandtzaeg P, Sandset PM, Joo GB, Ovstebo R, Abildgaard U, Kierulf P (1989) The quantitative association of plasma endotoxin, antithrombin, protein C, extrinsic pathway inhibitor and fibrinopeptide A in systemic meningococcal disease. Thromb Res 55: 459–470
Briegel J, Forst H, Kellermann W, Haller M, Peter K (1992) Haemodynamic improvement in refractory septic shock with cortisol replacement therapy [letter]. Intensive Care Med 18: 318
Briegel J, Kellermann W, Bittl M, Forst H, Hoffmann G, Haller M, Peter K (1992) Influence of physiological doses of hydrocortisone on phospholipase A2 activity in early septic shock [abstract]. Anesthesiology 77: A256
Briegel J, Kellermann W, Forst H, Haller M, Bittl M, Hoffmann GE, Büchler M, Uhl W, Peter K and the Phospholipase A2 Study Group (1994) Low-dose hydrocortisone infusion attenuates the systemic inflammatory response syndrome. Clin Investigator 72: 782–787
Brox JH, Osterud B, Bjorklid E, Fenton JW (1984) Production and availability of thromboplastin in endothelial cells: the effects of thrombin, endotoxin and platelets. Br J Haematol 57: 239–246
Bull BS, Bull MH (1994) Hypothesis: Disseminated intravascular inflammation as the inflammatory counterpart to disseminated intravascular coagulation. Proc Natl Acad Sci USA 91: 8190–8194
Burke-Gaffney A, Keenan AK (1993) Modulation of human endothelial cell permeability by combinations of the cytokines interleukin-1 Iß, tumor necrosis factor-a, and interferon-i Immunopharmacology 25: 1–9
Busund R, Straume B, Revhaug A (1993) Fatal course in severe meningococcemia: Clinical predictors and effect of transfusion therapy. Crit Care Med 21: 1699–1705
Carson SD, Johnson DR, Tracy SM (1993) Tissue factor and the extrinsic pathway of coagulation during infection and vascular inflammation. Eur Heart J 14 [Suppl K]: 98–104
Casey LC, Balk RA, Bone RC (1993) Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 119: 771–778
Cerra FB, Maddaus MA, Dunn DL, Wells CL, Konstantinides NN, Lehmann SL, Mann HJ (1992) Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ, failure in surgical intensive care unit patients. Arch Surg 127: 163–169
Chandler WL (1991) Treatment of thrombosis associated with septic shock [editorial]. J Lab Clin Med 118: 513–514
Clauss M, Gerlach M, Gerlach H, Brett J, Wang F, Familetti PC, Pan YCE, Olander JV, Connolly DT, Stern D (1990) Vascular permeability factor: A tumor-derived polypeptide that induces endothelial cell and monocyte procoagulant activity, and promotes monocyte migration. J Exp Med 172: 1535–1545
Clemmer TP, Fisher CJ, Bone RC, Slotman GJ, Metz CA, Thomas FO, The Methylprednisolone Severe Sepsis Study Group (1992) Hypothermia in the sepsis syndrome and clinical outcome. Crit Care Med 20: 1395–1401
Colman RW (1994) Disseminated intravascular coagulation due to sepsis. Semin Hematol 31 (Suppl 1]: 10–17
Conary JT, Parker RE, Christman BW, Faulks RD, King GA, Meyrick BO, Brigham KL (1994) Protection of rabbit lungs from endotoxin injury by in vivo hyperexpression of the prostaglandin G/H synthase gene. J Clin Invest 93: 1834–1840
Conway EM, Rosenberg RD (1988) Tumor necrosis factor suppresses transcription of the thrombomodulin gene in endothelial cells. Mol Cell Biol 8: 5588–5592
Craven DE (1992) Use of selective decontamination of the digestive tract–Is the light at the end of the tunnel red or green? Ann Intern Med 117: 609–611
Daly JM, Lieberman MD, Goldfete J, Shou J, Weintraub F; Rosato EF; Lavin P (1992) Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome. Surgery 112: 56–67
Damas P, Ledoux D, Nys M, Vrindts Y, de Groote D, Franchimont P, Lamy M (1992) Cytokine serum level during severe sepsis in human IL-6 as a marker of severity. Ann Surg 215: 356–362
Desjars P, Pinaud M, Potel G, Tasseau F, Touze MD (1987) A reappraisal of norepinephrine therapy in human septic shock. Crit Care Med 15: 134–137
Dhainaut JFA, Tenaillon A, Le Tulzo Y, Schlemmer B, Solet JP, Wolff M, Holzapfel L, Zeni F, Dreyfuss D, Mira JP, De Vathaire F, Guinot P, the BN 52021 Sepsis Study Group (1994) Platelet-actiavting factor receptor antagonist BN 52021 in the treatment of severe sepsis: A randomized, double-blind, placebo-controlled, multicenter clinical trial. Crit Care Med 22: 1720–1728
Dickneite G, Pâques EP (1993) Protection of DIC-induced mortality in Klebsiella peneumoniae-infected and LPS-treated rats by antithrombin III. In: Müller-Berghaus G, Madlener K, Blombäck M, ten Cate JW (eds) DIC: Pathogenesis, Diagnosis and Therapy of Disseminated Intravascular Fibrin Formation. Excerpta Medica, Amsterdam, pp 215–219
Dofferhoff AS, de Jong HJ, Bom VJ, van der Meer J, Limburg PC, de Vries-Hospers HG, Marrink J, Mulder PO, Weits J (1992) Complement activation and the production of inflammatory mediators during the treatment of severe sepsis in humans. Scand J Infect Dis 24: 197–204
Dominioni L, Diongi R, Zanello M, Monico R, Cremaschi R, Diongi R, Ballabio A, Massa M, Comelli M, dal Ri P, Pisati P (1987) Sepsis score and acute-phase protein response as predictors of outcome in septic surgical patients. Arch Surg 122: 141–146
Dominioni L, Dionigi R, Zanello M, Chiaranda M, Diongi R, Acquarolo A, Ballabio A, Sguotti C (1991) Effects of high-dose IgG on survival of surgical patients with sepsis scores of 20 or greater. Arch Surg 126: 236–240
Drake TA, Cheng J, Chang A, Taylor FB (1993) Expression of tissue factor, thrombomodulin, and E-selectin in baboons with lethal Escherichia-coli sepsis. Am J Pathol 142: 1458–1470
Edgington TS, Mackman N, Fan ST, Ruf W (1992) Cellular immune and cytokine pathways resulting in tissue factor expression and relevance to septic shock. Nouv Rev Fr Haematol 34 [Suppl]: S15–827
Elebute EA, Stoner HB (1983). The grading of sepsis. Br J Surg 70: 29–31
Emerson TE, Fournel MA, Redens TB, Taylor FB (1989) Efficacy of antithrombin III supplementation in animal models of fulminant Escherichia coli endotoxemia or bacteremia. Am J Med 87 (3B): 27S - 33S
Ferrari-Baliviera E, Mealy K, Smith RI, Wilmore DW (1989) Tumor necrosis factor induces adult respiratory distress syndrome in rats. Arch Surg 124: 1400–1405
Filz HP, Förster H (1994) Sepsis nach Splenektomie–das OPSI-Syndrom. Intensivmedizin 31: 288–290
Fink MP (1992) Selective digestive decontamination: A gut issue for the nineties [editorial]. Crit Care Med 20: 559–562
Fisher CJ, Dhainaut JF, Opal SM, Pribble JP, Balk RA, Slotman GJ, Iberti TJ, Rackow EC, Shapiro MJ, Greenman RL, Reines HD et al (1994) Recombinant human interleukin 1 receptor antagonist in the treatment of patients with sepsis syndrome. Results from a randomized, double-blind, placebo-controlled trial. JAMA 271: 1836–1843
Fisher CJ, Marra MN, Palardy JE, Marchbanks CR, Scott RW, Opal SM (1994) Human neutrophil bactericidal/permeability-increasing protein reduces mortality rate from endotoxin challenge: A placebo-controlled study. Crit Care Med 22: 553–558
Fletcher JR (1991) Ibuprofen in patients with severe sepsis [editorial]. Crit Care Med 19: 1331–1332
Fourrier F, Lestavel P, Chopin C, Marey A, Goudemand J, Rime A, Mangalaboyi J (1990) Meningococcemia and purpura fulminans in adults: acute deficiencies of proteins C and S and early treatment with antithrombin III concentrates. Intensive Care Med 16: 121–124
Fourrier F, Chopin C, Goudemand J, Hendrycx S, Caron C, Rime A, Marey A, Lestavel P (1992) Septic shock, multiple organ failure, and disseminated intravascular coagulation. Compared patterns of antithrombin III, protein C, and protein S deficiencies. Chest 101: 816–823
Fourrier F, Chopin C, Huart JJ, Runge I, Caron C, Goudemand J (1993) Double-blind, placebo-controlled trial of antithrombin III concentrates in septic shock with disseminated intravascular coagulation. Chest 104: 882–888
Freund M, Ostendorf P, Gärtner VH, Tidow S (1981) OPSI–Ein Fall foudroyant verlaufender Sepsis. Internist 22: 175–179
Freye E, Knüfermann V (1994) Keine Hemmung der intestinalen Motilität nach Ketamin/Midazolamnarkose. Anaesthesist 43: 87–91
Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S, French Study Group on Selective Decontamination of the Digestive Tract (1992) A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 326: 594–599
Gattinoni L, Pesenti A, Bombino M, Baglioni S, Rivolta M, Rossi F, Rossi G, Fumagalli R, Marcolin R, Mascheroni D, Torresin A (1988) Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 69: 824–832
George JN, Shattil SJ (1991) The clinical importance of acquired abnormalities of platelet function. N Engl J Med 324: 27–39
Glauser MP, Zanetti G, Baumgartner JD, Cohen J (1991) Septic shock: pathogenesis. Lancet 338: 732–736
Gomez A, Wang R, Unruh H, Light RB, Bose D, Chau T, Correa E, Mink S (1990) Hemofiltration reverses left ventricular dysfunction during sepsis in dogs. Anesthesiology 73: 671–685
Goode HF, Webster NR (1993) Free radicals and antioxidants in sepsis. Crit Care Med 21: 1770–1776
Greenman RL, Schein RM, Martin MA, Wenzel RP, Maclntyre NR, Emmanuel G, Chmel H, Kohler RB, McCarthy M, Plouffe J et al. (1991) A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. The XOMA Sepsis Study Group. JAMA 266: 1097–1102
Grootendorst AF, van Bommel EFH, van der Hoven B, van Leengoed LAMG, van Osta ALM (1992) High volume hemofiltration improves right ventricular function in endotoxin-induced shock in the pig. Intensive Care Med 18: 235–240
Guerrero R, Velasco F, Rodriguez M, Lopez A, Rojas R, Alvarez MA, Villalba R, Rubio V, Torres A, del Castillo D (1993) Endotoxin-induced pulmonary dysfunction is prevented by Cl-esterase inhibitor. J Clin Invest 91: 2754–2760
Hack CE, Voerman HJ, Eisele B, Keinecke HO, Nuijens JH, Eerenberg AJM, Ogilvie A, Schijndel RJMS, van, Delvos U, Thijs LG (1992) Cl-esterase inhibitor substitution in sepsis [letter]. Lancet 339: 378
Hack CE, Ogilvie AC, Eisele B, Eerenberg AJM, Wagstaff J, Thijs LG (1993) Cl-inhibitor substitution therapy in septic shock and in the vacular leak syndrome induced by high doses of interleukin-2. Intensive Care Med 19: S19 - S28
Hackshaw KV, Parker GA, Roberts JW (1990) Naloxone in septic shock. Crit Care Med 18: 47–51
Hammond JMJ, Potgieter PD, Saunders GL, Forder AA (1992) Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 340: 5–9
Hardaway RM (1978) Acute respiratory distress syndrome and disseminated intravascular coagulation. South Med J 71: 596–598
Hardaway RM, Williams CH, Marvasti M, Farias M, Tseng A, Pinon I, Yanez D, Martinez M, Navar J (1990) Prevention of adult respiratory distress syndrome with plasminogen activator in pigs. Crit Care Med 18: 1413–1418
Hardaway RM, Harke H, Williams CH (1994) Fibrinolytic agents–A new approach to the treatment of adult respiratory distress syndrome. Adv Ther 11: 43–51
Harke H (1991) Fibrinolysetherapie bei chirurgisch behandelten Intensivpatienten. Klin Wochenschr 69 [Suppl 26]: 150–156
Hasegawa N, Husari AW, Hart WT, Kandra TG, Raffin TA (1994) Role of the coagulation system in ARDS. Chest 105: 268–277
Hayes MA, Timmins AC, Yau EHS, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330: 1717–1722
Heard SO, Perkins MW, Fink MP (1992) Tumor necrosis factor-causes myocardial depression in guinea pigs. Crit Care Med 20: 523–527
High KM, Snider MT, Richard R, Russell GB, Stene JK, Campbell DB, Aufiero TX, Thieme GA (1992) Clinical trials of an intravenous oxygenator in patients with adult respiratory distress syndrome. Anesthesiology 77: 856–863
Hinshaw LB, Emerson TE, Taylor FB, Chang ACK, Duerr M, Peer GT, Flournoy DJ, White GL, Kosanke SD, Murray CK, Xu R, Passey RB, Fournel MA (1992) Lethal Staphylococcus aureus-induced shock in primates: Prevention of death with ant-TNF antibody. J Trauma 33: 568–573
Hörmann C, Benzer H, Baum M, Wicke K, Putensen C, Putz G, Hartlieb S (1994) Bauchlagerung im ARDS. Anaesthesist 43: 454–462
Holaday JW, Faden AI (1978) Naloxone reversal of endotoxin hypotension suggests role of endorphins in shock. Nature 275: 450–451
Holaday JW, Ruvio BA, Faden AI (1981) Thyrotropin releasing hormone improves blood pressure and survival in endotoxic shock. Eur J Pharmacol 74: 101–105
Hollenberg SM, Cunnion RE, Parrillo JE (1992) Effect of septic serum on vascular smooth muscle: In vitro studies using rat aortic rings. Crit Care Med 20: 993–998.
Hotchkiss RS, Karl IE (1992) Reevaluation of the role of cellular hypoxia and bioenergetic failure in sepsis. JAMA 267: 1503–1510
Hudson LD, Milberg JA, Anardi D, Maunder RJ (1995) Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med 151: 293–301
Idell S, Koenig KB, Fair DS, Martin TR, McLarty J, Maunder RI (1991) Serial abnormalities of fibrin turnover in evolving adult respiratory distress syndrome. Am J Physiol 261: L240 - L248
Jackson RJ, Smith SD, Rowe MI (1990) Selective bowel decontamination results in gram-positive translocation. J Surg Res 48: 444–447
Jepsen S, Herlevsen P, Knudsen P, Bud MI, Klausen NO (1992) Antioxidant treatment with N-acetylcysteine during adult respiratory distress syndrome: A prospective, randomized, placebo-controlled study. Crit Care Med 20: 918–923
Jin H, Yang R, Marsters S, Ashkenazi A, Bunting S, Marra MN, Scott RW, Baker JB (1995) Protection against endotoxic shock by bactericidal/permeability-increasing protein in rats. J Clin Invest 95: 1947–1952
Jochum M, Inthorn D, Waydhas Ch, Fritz H (1994) Modulation of inflammatory mediators by AT III-therapy [abstract]. Intensive Care Med 20 [Suppl 1]: S119
Johnson D, Hurst T, Prasad K, Wilson T, Saxena A, Murphy F, Mayers I (1994) Lazaroid pretreatment preserves gas exchange in endotoxin-treated dogs. J Crit Care 9: 213–223
Kalter ES, Daha MR, Cate JW ten, Verhoef J, Bouma BN (1985) Activation and inhibition of Hageman factor-dependent pathways and the complement system in uncomplicated bacteremia or bacterial shock. J Infect Dis 151: 1019–1027
Kirchhofer D, Tschopp TB, Hadvary P, Baumgartner HR (1994) Endothelial cells stimulated with tumor necrosis factor-express varying amounts of tissue factor resulting in inhomogenous fibrin deposition in a native blood flow system. Effects of thrombin inhibitors. J Clin Invest 93: 2073–2083
Klausner JM, Paterson IS, Goldman G, Kobzik L, Lelzuk S, Skornick Y, Eberlein T, Valeri R, Shepro D, Hechtman HB (1991) Interleukin-2-induced lung injury is mediated by oxygen free radicals. Surgery 109: 169–175
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: A severity of disease classification system. Crit Care Med 13: 818–829
Kollef MH, Schuster DP (1995) The acute respiratory distress syndrome. N Engt J Med 332: 27–37
Koltai M, Hosford D, Braquet P (1992) Role of PAF and cytokines in microvascular tissue injury. J Lab Clin Med 119: 461–466
Kreimeier U, Mesmer K (1992) Einsatz hypertoner NaCI-Lösungen zur primären Volumentherapie. Zentralbl Chir 117: 532–539
Kreimeier U, Frey L, Dentz J, Herbei T, Messmer K (1991) Hypertonic saline dextran resuscitation during the initial phase of acute endotoxemia: effect on regional blood flow. Crit Care Med 19: 801–809
Lasch HG, Heene DH (1975) Heparin therapy of diffuse intravascular coagulation ( DIC ). Thromb Diath Haemorrh 33: 105–106
Leclerc F, Hazelzet J, Jude B, Hofhuis W, Hue V, Martinot A, Van der Voort E (1992) Protein C and S deficiency in severe infectious purpura of children: a collaborative study of 40 cases. Intensive Care Med 18: 202–205
Levi M, ten Cate H, Bauer KA, van der Poll T, Edgmgton TS, Butler HR, van Deventer SJH, Hack CE, ten Cate JW, Rosenberg RD (1994) Inhibition of endotoxin-induced activation of coagulation and fibrinolysis by pentoxifylline or by a monoclonal anti-tissue factor antibody in chimpanzees. J Clin Invest 93: 114–120
Lewis JF, Jobe AH (1993) Surfactant and the adult respiratory distress syndrome. Am Rev Respir Dis 147: 218–233
Liban E, Raz S (1969) A clinicopathologic study of fourteen cases of amniotic fluid embolism. Am J Clin Pathol 51: 477–486
Lin PJ, Chang CH, Chang JP (1994) Reversal of refractory hypotension in septic shock by inhibitor of nitric oxide synthase. Chest 106: 626–629
Liu P, Vonderfecht SL, McGuire GM, Fisher MA, Farhood A, Jaeschke H (1994) The 21aminosteroid tirilazad mesylate protects against endotoxin shock and acute liver failure in rats. J Pharmacol Exp Ther 271: 438–445
Lorente JA, Garcia-Frade LJ, Landfn L, Pablo R de, Torrado C, Renes E, Garcia-Avello A (1993) Time course of hemostatic abnormalities in sepsis and its relation to outcome. Chest 103: 1536–1542
Lübbe AS, Garrison RN, Cryer HM, Alsip NL, Harris PD (1992) EDRF as a possible mediator of sepsis-induced arteriolar dilation in skeletal muscle. Am J Physiol 262: H880887
Mackman N, Brand K, Edgington TS (1991) Lipopolysaccharide-mediated transcriptional activation of the human tissue factor gene in THP-1 monocytic cells requires both activator protein 1 and nuclear factor B binding sites. J Exp Med 174: 1517–1526
Mammen EF, Miyakawa T, Phillips TF, Assarian GS, Brown JM, Murano G (1985) Human antithrombin concentrates and experimental disseminated intravascular coagulation. Se-min Thromb Hemost 11: 373–383
Marik PE, Sibbald WJ (1993) Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 269: 3024–3029
Marra MN, Wilde CG, Griffith JE, Snable JL, Scott RW (1990) Bactericidal/permeabilityincreasing protein has endotoxin-neutralizing activity. J Immunol 144: 662–666
Marshall JC, Christou NV, Meakins JL (1993) The gastrointestinal tract. The „undrained abscess“ of multiple organ failure. Ann Surg 218: 111–119
Martin C, Saux P, Eon B, Aknin P, Gouin F (1990) Septic shock: a goal-directed therapy using volume loading, dobutamine and/or norepinephrine. Acta Anaesthesiol Scand 34: 413–417
Mason JW, Kleeberg U, Dolan P, Colman RW (1970) Plasma kallikrein and Hageman factor in Gram-negative bacteremia. Ann Intern Med 73: 545–551
McManus ML, Churchwell KB (1993) Coagulopathy as a predictor of outcome in meningococcal sepsis and the systemic inflammatory response syndrome with purpura. Crit Care Med 21: 706–711
McMullin M, Johnston G (1993) Long term management of patients after splenectomy. Pneumococcal vaccine, lifelong penicillin, and avoidance of protozoal infections [editorial]. Br Med J 307: 1372–1373
Meadows D, Edwards JD, Wilkins RG, Nightingale P (1988) Reversal of intractable septic shock with norepinephrine therapy. Crit Care Med 16: 663–666
Meakins JL, Marshall JC (1986) The gastrointestinal tract: The ‘motor’ of MOF ( Panel discussion - multiple-organ-failure syndrome ). Arch Surg 121: 197–201
Michie HR, Manogue KR, Spriggs DR, Revhaug A, O’Dwyer S, Dinarello CA, Cerami A, Wolff SM, Wilmore DW (1988) Detection of circulating tumor necrosis factor after endotoxin administration. N Engl J Med 318: 1481–1486
Mira JP, Fabre JE, Baigorri F, Coste J, Annat G, Artigas A, Nitenberg G, Dhainaut JFA (1994) Lack of oxygen supply dependency in patients with severe sepsis. A study of oxygen delivery increased by military antishock trouser and dobutamine. Chest 106: 1524–1531
Mitaka C, Hirata Y, Makita K, Nagura T, Tsunoda Y, Amaha K (1993) Endothelin-1 and atrial natriuretic peptide in septic shock. Am Heart J 126: 466–468
Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, Kellum JM, Welling RE, Moore EE (1992) Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216: 172–183
Moreau R, Hadengue A, Soupison T, Kirstetter P, Mamzer MF, Vanjak D, Vauquelin P, Assous M, Sicot C (1992) Septic shock in patients with cirrhosis: Hemodynamic and metabolic characteristics and intensive care unit outcome. Crit Care Med 20: 746–750
Nast-Kolb, Waydhas Ch, Jochum M, Schweiberer L (1994) Early antithrombin III treatment of patients with severe multiple injuries [abstract]. Intensive Care Med 20 [Suppl 1]: S121
Nawroth PP, Stern DM (1986) Modulation of endothelial cell hemostatic properties by tumor necrosis factor. J Exp Med 163: 740–745
Nürnberger W, Göbel U, Stannigel H, Eisele B, Janssen A, Delvos U (1992) Cl-inhibitor concentrate for sepsis-related capillary leak syndrome [letter]. Lancet 339: 990
Osterud B, Flaegstad T (1983) Increased tissue thromboplastin activity in monocytes of patients with meningococcal infection: related to an unfavourable prognosis. ‘f iromb Haemost 49: 5–7
Parrillo JE, Burch C, Shelhamer JH, Parker MM, Natanson C, Schuette W (1985) A circulating myocardial depressant substance in humans with septic shock. Septic shock patients with a reduced ejection fraction have a circulating factor that depresses in vitro myocardial cell performance. J Clin Invest 76: 1539–1553
Patel RT, Deen KI, Youngs D, Warwick J, Keighley RB (1994) Interleukin 6 is a prognostic indicator of outcome in severe intra-abdominal sepsis. Br J Surg 81: 1306–1308
Petros A, Bennett D, Vallance P (1991) Effect of nitric oxide synthase inhibitors on hypotension in patients with septic shock. Lancet 338: 1557–1558
Pilz G, Werdan K (1989) Score-Systeme bei Sepsis and septischem Schock: Diagnosestellung, Verlaufsbeurteilung and Therapiekontrolle, Intensivmed 26/Suppl 1: 65–71
Pilz G, Kreuzer E, Kääb S, Appel R, Werdan K (1994) Early sepsis treatment with immunoglobulins after cardiac surgery in score-identified high-risk patients. Chest 105: 76–82
Pollack M (1992) Blood exchange and plasmapheresis in sepsis and septic shock [editorial]. Clin Infect Dis 15: 431–433
Poole GV, Muakkassa FF, Griswold JA (1992) Pneumonia, selective decontamination, and multiple organ failure. Surgery 111: 1–3
Redens TB, Emerson TE (1989) Antithrombin-III treatment limits disseminated intravascular coagulation in endotoxemia. Circ Shock 28: 49–58
Redl-Wenzl EM, Armbruster C, Edelmann G, Fischl E, Kolacny M, Wechsler-Fördös A, Sporn P (1990) Noradrenalin im „High Output-Low Resistance State“ beim septischen Adominalpatienten. Anaesthesist 39: 525–529
Reinhart K, Spies CD, Meier-Hellmann A, Bredle DL, Hannemann L, Specht M, Schaffartzik W (1995) N-acetylcysteine preserves oxygen consumption and gastric mucosal pH during hyperoxic ventilation. Am J Respir Crit Care Med 151: 773–779
Reynolds HN, Haupt MT, Thill-Baharozian MC, Carlson RW (1988) Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA 260: 3446–3450
Ridings PC, Windsor ACJ, Sugerman HJ, Kennedy E, Sholley MM, Blocher CR, Fisher BJ, Fowler AA (1994) Beneficial cardiopulmonary effects of pentoxifylline in experimental sepsis are lost once septic shock is established. Arch Surg 129: 1144–1152
Rossaint R, Falke KJ, L6pez F, Slama K, Pison U, Zapol WM (1993) Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 328: 399–405
Rossaint R, Lewandowski K, Pappert D, Slama K, Falke K (1994) Die Therapie des ARDS. Teli 1: Aktuelle Behandlungsstrategien einschließlich des extrakorporalen Gasaustauschs. Anaesthesist 43: 298–308
Rossaint R, Pappert D, Gerlach H, Falke K (1994) Die Therapie des ARDS. Teil 2: Neue Behandlungsmethoden - erste klinische Erfahrungen. Anaesthesist 43: 364–375
Ronco C, Tetta C, Lupi A, Galloni E, Bettini MC, Sereni L, Mariano F, DeMartino A, Montrucchio G, Camussi G, La Greca G (1995) Removal of platelet-activating factor in experimental continuous arteriovenous hemofiltration. Crit Care Med 23: 99–107
Rothwell PM, Udwadia ZF, Lawler PG (1991) Cortisol response to corticotropin and survival in septic shock. Lancet 337: 582–583
Royall JA, Berkow RL, Beckman JS, Cunningham MK, Matalon S, Freeman BA (1989) Tumor necrosis factor and interleukin 1 increase vascular endothelial permeability. Am J Physiol 257: L399 - L410
Ruokonen E, Takala J, Kari A, Alhava E (1991) Septic shock and multiple organ failure, Crit Care Med 19: 1146–1151
Sanchez-Canto L, Rode HN, Yun TJ, Christou NV (1991) Tumor necrosis factor alone does not explain the lethal effect of lipopolysaccharide. Arch Surg 126: 231–235
Saß W, Bergholz M, Seifert J, Hamelmann H (1984) Splenektomie bei Erwachsenen and das OPSI-Syndrom. Dtsch Med Wochenschr 109: 1249–1254
Sawyer RG, Adams RB, May AK, Rosenlof LK, Pruett TL, Wilmore DW, Dellinger EP, Vangoor H (1993) Antitumor necrosis factor antibody reduces mortality in the presence of antibiotic-induced tumor necrosis factor release. Arch Surg 128: 73–78
Schedel I, Dreikhausen U, Nentwig B, Höckenschnieder M, Rauthmann D, Balikcioglu S, Coldewey R, Deicher H (1991) Treatment of Gram-negative septic shock with an immunoglobulin preparation: A prospective, randomized clinical trial. Crit Care Med 19: 11041113
Schilling J, Cakmakci M, Bättig U, Geroulanos S (1993) A new approach in the treatment of hypotension in human septic shock by NG-monomethyl-L-arginine, an inhibitor of the nitric oxide synthetase. Intensive Care Med 19: 227–231
Schneider AJ, Voerman HJ (1991) Abrupt hemodynamic improvement in late septic shock with physiological doses of glucocorticoids [letter]. Intensive Care Med 17: 436–437
Schumann RR, Leong SR, Flaggs GW, Gray PW, Wright SD, Mathison JC, Tobias PS, Ulevitch RJ (1990) Structure and function of lipopolysaccharide binding protein. Science 249: 14291431
Schuster DP (1995) Fluid management in ARDS: „keep them dry“ or does it matter? Intensive Care Med 21: 101–103 (Editorial)
Schützer KM, Larsson A, Risberg B, Falk A (1993) Lung protein leakage in feline septic shock. Am Rev Respir Dis 147: 1380–1385
Seitz R, Wolf M, Egbring R, Havemann K (1989) The disturbance of hemostasis in septic shock: role of neutrophil elastase and thrombin, effects of antithrombin III and plasma substitution. Eur J Haematol 43: 22–28
Semrad SD, Rose ML, Adams JL (1993) Effect of tirilazad mesylate (U74006F) on eicosanoid and tumor necrosis factor generation in healthy and endotoxemic neonatal calves. Circ Shock 40: 235–242
Shenkar R, Abraham E (1995) Effects of treatment with the 21-aminosteroid, U74389F, on pulmonary cytokine expression following hemorrhage and resuscitation. Crit Care Med 23: 132–139
Sheth SB, Carvalho AC (1991) Protein S and C alterations in acutely ill patients. Am J Hematol 36: 14–19
Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186
Shoemaker WC, Appel PL, Kram HB (1992) Role of oxygen debt in the development of organ failure sepsis, and death in high-risk surgical patients. Chest 102: 208–215
Sibbald WJ, Vincent JL (1995) Roundtable conference on clinical trials for the treatment of sepsis. Brussels, March 12–14, 1994. Chest 107: 522–527
Siler TM, Swierkosz JE, Hyers TM, Fowler AA, Webster RO (1989) Immunoreactive interleukin-1 in bronchoalveolar lavage fluid of high-risk patients and patients with the adult respiratory distress syndrome. Exp Lung Res 15: 881–894-
Sitrin RG, Brubaker PG, Fantone JC (1987) Tissue fibrin deposition during acute lung injury in rabbits and its relationship to local expression of procoagulant and fibrinolytic activities. Am Rev Respir Dis 135: 930–936
Smith EF, Kinter LB, Jugus M, Zeid R (1988) Effect of the thrombolytic agent, streptokinase, on the responses to endotoxemia in conscious rats. Circ Shock 25: 85–94
Snyder F (1990) Platelet-activating factor and related acetylated lipids as potent biologically active cellular mediators. Am J Physiol 259: C697 - C708
Spies CD, Reinhart K, Witt I, Meier-Hellmann A, Hannemann L, Bredle DL, Schaffartzik W (1994) Influence of N-acetylcysteine on indirect indicators of tissue oxygenation in septic shock patients: Results from a prospective, randomized, double-blind study. Crit Care Med 22: 1738–1746
Springer TA (1990) Adhesion receptors of the immune system. Nature 346: 425–434
Stein B, Pfenninger E, Grünert A, Schmitz JE, Hudde M (1990) Influence of continuous haemofiltration on haemodynamics and central blood volume in experimental endotoxic shock. Intensive Care Med 16: 494–499
Stephens KE, Ishizaka A, Larrick JW, Raffin TA (1988) Tumor necrosis factor causes increased pulmonary permeability and edema. Comparison to septic acute lung injury. Am Rev Respir Dis 137: 1364–1370
Stevens LE (1983) Gauging the severity of surgical sepsis. Arch Surg 118: 1190–1192
Stewart TE, Valenza F, Ribeiro SP, Wener AD, Volgyesi G, Mullen JBM, Slutsky AS (1995) Increased nitric Oxide in exhaled gas as an early marker of lung inflammation in a model of sepsis. Am J Respir Crit Care Med 151: 713–718
Stoutenbeek CP, Saene HKF van, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 10: 185–192
Snffredini AF, Harpel PC, Parillo JE (1989) Promotion and subsequent inhibition of plasminogen activaton after administration of intravenous endotoxin to normal subjects. N Engl J Med 320: 1165–1172
Suter PM, Suter S, Girardin E, Roux-Lombard P, Grau GE, Dayer JM (1992) High bronchoalveolar levels of tumor necrosis factor and its inhibitors, interleukin-1, interferon, and elastase, in patients with adult respiratory distress syndrome after trauma, shock, or sepsis. Am Rev Respir Dis 145: 1016–1022
Takenaka I, Ogata M, Koga K, Matsumoto T, Shigematsu A (1994) Ketamine suppresses endotoxin-induced tumor necrosis factor alpha production in mice. Anesthesiology 80: 402–408
Taylor FB, Chang A, Esmon CT, D’Angelo A, Vigano-D’Angelo S, Blick KE (1987) Protein C prevents the coagulopathic and lethal effects of Escherichia cal infusion in the baboon. J Clin Invest 79: 918–925
Taylor FB, Chang A, Ruf W, Morrissey JH, Hinshaw L, Catlett R, Blick K, Edgington TS (1991) Lethal E. coli septic shock is prevented by blocking tissue factor with monoclonal antibody. Circ Shock 33: 127–134
The Veterans Administration Systemic Sepsis Cooperative Study Group (1987) Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N Engl J Med 317: 659–665
Thiel M, Bardenheuer HJ (1994) Medikamentöse Therapie der Sepsis. Eine Indikation für Pentoxifyllin? Anaesthesist 43: 249–256
Tonnesen E, Hansen MB, Höhndorf K, Diamant M, Bendtzen K, Wanscher M, Toft P (1993) Cytokines in plasma and ultrafiltrate during continuous arteriovenous haemofiltration. Anaesth Intens Care 21: 752–758
Tracey KJ (1991) Tumor necrosis factor (cachectin) in the biology of septic shock syndrome. Circ Shock 35: 123–128
Tremel H, Kienle B, Weilemann LS, Stehle P, Fürst P (1994) Glutamine dipeptide-supplemented parenteral nutrition maintains intestinal function in the critically ill. Gastroenterology 107: 1595–1601
Tuchschmidt J, Fried J, Astiz M, Rackow E (1992) Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102: 216–220
van der Poll T, Buller HR, ten Cate H, Wortel CH, Bauer KA, van Deventer SJ, Hack CE, Sauerwein HP, Rosenberg RD, ten Cate JW (1990) Activation of coagulation after administration of tumor necrosis factor to normal subjects. N Engl J Med 322: 1622–1627
van der Poll T, Levi M, Buller HR, van Deventer SJ, de Boer JP, Hack CE, ten Cate JW (1991) Fibrinolytic response to tumor necrosis factor in healthy subjects. J Exp Med 174: 729–732
van Deventer SJH, Buller HR, ten Cate JW, Aarden LA, Hack CE, Sturk A (1990) Experimental endotoxemia in humans: analysis of cytokine release and coagulation, fibrinoIytic, and complement pathways. Blood 76: 2520–2526
Vinazzer HA (1995) Antithrombin III in shock and disseminated intravascular coagulation. Clin Appl Thrombosis/Hemostasis 1: 62–65
Vincent JL, Bihari D (1992) Sepsis, severe sepsis or sepsis syndrome: need for clarification [editorial]. Intensive Care Med 18: 255–257
Vincent JL, Roman A, Backer D de, Kahn RJ (1990) Oxygen uptake/supply dependency. Effects of short-term dobutamine infusion. Am Rev Respir Dis 142: 2–7
Vincent JL, Bakker J, Marécaux G, Schandene L, Kahn RJ, Dupont E (1992) Administration of anti-TNF antibody improves left ventricular function in septic shock patients. Results of a pilot study. Chest 101: 810–815
Voerman HJ, Stehouwer CDA, Kamp GJ van, Schindel SRJM van, Groeneveld ABJ, Thijs LG (1992) Plasma endothelin levels are increased during septic shock. Crit Care Med 20: 1097–1101
Voss R, Matthias FR, Borkowski G, Reitz D (1990) Activation and inhibition of fibrinolysis in septic patients in an internal intensive care unit. Br J Haematol 75: 99–105
Walmrath D, Schneider T, Pilch J, Grimminger F, Seeger W (1993) Aerosolised prostacyclin in adult respiratory distress syndrome. Lancet 342: 961–962
Wegener T, Wallin R, Saldeen T (1986) Effect of N-acetylcysteine on fibrin deposition in the rat lung due to intravascular coagulation. Ups J Med Sci 91: 45–52
SJ (1989) Tissue destruction by neutrophils. N Engl J Med 300: 365–376
Werdan K, Boekstegers P, Müller U, Pfeifer A, Pilz G, Reithmann C, Hallström S, Koidl B, Schuster HP, Schlag G (1991) Akute septische Kardiomyopathie: Bestandteil des Multiorganversagens in der Sepsis? Med Kiln 86: 526–534
Wright SD, Ramos RA, Tobias PS, Ulevitch RJ, Mathison JC (1990) CD14, a receptor for complexes of lipopolysaccharide ( LPS) and LPS binding protein. Science 249: 1431–1433
Zabel P, Wolter DT, SchÖnharting MM, Schade OF (1989) Oxpentifylline in endotoxaemia. Lancet 334: 1474–1477
Ziegler EJ, Fisher CJ, Sprung CL, Straube RC, Sadoff JC, Foulke GE, Wortel CH, Fink MP, Dellinger RP et al (1991) Treatment of Gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A Randomized, double-blind, placebo-controlled trial. N Eng! J Med 324: 429–436
Ziegler TR, Young LS, Benfell K, Scheltinga M, Hortos K, Bye R, Morrow FD, Jacobs DO, Smith RJ, Antin JH et al (1992) Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study. Ann Intern Med 116: 821–828
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Böhrer, H., Nawroth, P.P. (1996). Pathophysiologie, Klinik und Therapie intensivmedizinischer Krankheitsbilder mit DIC. In: Hach-Wunderle, V., Nawroth, P.P. (eds) Lebensbedrohliche Gerinnungsstörungen in der Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-12220-4_1
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