Beruflich Dokumente
Kultur Dokumente
TO INJURY
multi-organ
dysfunction
syndrome (MODS)
Hormonal
Cytokines
and
other
substances
Cellular response
Tissue response
INFLAMMATORY RESPONSE
HORMONES
WITH
SIGNIFICANT
CLINICAL
IMPACT
Adrenocorticotropic hormone (ACTH)
Glucocoticoids (Cortisol)
Mineralcorticoids
Metabolic effects:
o Potentiates the action of glucagon and
epinephrine causing hyperglycemia
o In the liver it favors gluconeogenesis
Polypeptides
Insulin
MEDIATORS OF INFLAMMATION
Cytokines
Heat shock proteins
Reactive oxygen metabolites
Eicosanoids
Fatty acid metabolites
Kallikrein-kinin system
Serotonin
Histamines
Cytokines
Temperature 38C or
36C
WBC 12,000/mm3 or
4,000mm3 or
TERMS
2
SIRS
describes
a
process
whereas
SEPSIS/MODS/MOF describes the outcome of
that process
Ebb phase
o Elevated blood glucose level
o Normal glucose production
o Elevated FFA level
o Low insulin concentration
o Elevated levels of catecholamines and
glucagon
o Elevated blood lactate levels
o Depressed O2 consumption
o Below normal cardiac output
o Below normal core temperature
o Dominated by cardiovascular instability
o Alterations in circulating blood volume
o Impairment of O2 transport
o Heightened autonomic activity
Flow phase
o Normal or slightly elevated blood
glucose level
o Increased glucose production
o Normal or slightly elevated free fatty
acid levels
o Normal
or
elevated
insulin
concentration
o High normal or elevated levels of
catecholamines and glucagon levels
o Normal blood lactate level
o Elevated O2 consumption
o Increased cardiac output
o Elevated core temperature
Anabolic phase
o Repletion of lean tissue and fat stores
o Restoration of strength and stamina
begins
MODS/MOF
Infection
peritonitis,
intraabdominal
infections, pneumonia, necrotinizing soft tissue
infections
Inflammation pancreatitis
Intoxication
drug reactions, arsenic
intoxication, drug overdose
Idiopathic
factors
thrombonic
thrombocytopenic purpura, hypoadrenalism,
pheochromocytoma
Organ system involved and the indicator of
dysfunction
GIT bleeding
o
o
Neurologic dysfunction
usually
Hepatic dysfunction
ICU jaundice
o Increased serum bilirubin levels
(These conditions are not life threatening)
Cardiovascular dysfunction
Ileus
GI bleeding
Bacterial translocation
o Gut barrier theory is based on the
principle that the gut microorganisms
which are normally present in the gut
lumen translocate outside causing
infection and eventually sepsis
ICU
INTERVENTIONS
TO
REDUCE
MORTALITY AND ATTENUATE ORGAN
DYSFUNCTION
OBJECTIVE
RESUSCITATION
Prophylaxis
ICU Support
INTERVENTION
Early
goal-directed
resuscitation
Selective
digestive
tract decontamination
Restrictive transfusion
strategy
Low
tidal
volume
ventilation
Daily wakening
Tight glucose control
Enteral feeding
Activated Proteins
Corticosteriods
Antibody for TNF
Resuscitation
After load
(Adequate
urine
output,
reduction of lactic acidosis)
Prophylaxis
Activated protein
Corticosteroids
Antibody to TNF
Outcome or Prognosis