Microvascular changes explain the "two-hit" theory of multiple organ failure

Annals of Surgery
R N GarrisonP D Harris

Abstract

The objective was to determine intestinal microvascular endothelial cell control after sequential hemorrhage and bacteremia. Sepsis that follows severe hemorrhagic shock often results in multiple system organ failure (MSOF) and death. The sequential nature of this clinical scenario has led to the idea of a "two-hit" theory for the development of MSOF, the hallmark of which is peripheral vasodilation and acidosis. Acute bacteremia alone results in persistent intestinal vasoconstriction and mucosal hypoperfusion. Little experimental data exist to support the pathogenesis of vascular dysregulation during sequential physiologic insults. We postulate that hemorrhagic shock followed by bacteremia results in altered microvascular endothelial cell control of dilation and blood flow. Rats underwent volume hemorrhage and resuscitation. A sham group underwent the vascular cannulation without hemorrhage and resuscitation, and controls had no surgical manipulation. After 24 and 72 hours, the small intestine microcirculation was visualized by in vivo videomicroscopy. Mean arterial pressure, heart rate, arteriolar diameters, and A1 flow by Doppler velocimetry were measured. Endothelial-dependent dilator function was determined by the topical ...Continue Reading

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Citations

May 16, 2000·Critical Care Medicine·K SchindlerG Sunder-Plassmann
May 12, 2000·Critical Care Medicine·D J BertgesR L Delude
Jun 30, 2007·American Journal of Respiratory and Critical Care Medicine·Sjoukje H SlofstraC Arnold Spek
May 19, 2010·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Maria-Angeles AllerJaime Arias
Dec 10, 2009·World Journal of Gastroenterology : WJG·Chong LiuShu-Wen Zhang
Jul 20, 2011·Journal of Emergencies, Trauma, and Shock·Fabrizio Giuseppe Bonanno
Jul 16, 2011·The Veterinary Clinics of North America. Small Animal Practice·Kelly W McCord, Craig B Webb
Dec 5, 2014·Journal of Veterinary Emergency and Critical Care·Laura B AtecaLesley G King
Feb 13, 2001·The Journal of Surgical Research·D J KooP Wang
Jul 18, 2000·The Journal of Surgical Research·R Anup, K A Balasubramanian
May 29, 2016·The American Journal of Emergency Medicine·Linlin MaTao Wang
Sep 17, 2004·Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research·Elton Luiz Schmidt WeberLisiane Piekala
Feb 25, 2005·Anesthesia and Analgesia·Claudio ContaldoDominique Erni
Nov 13, 2001·International Journal of Experimental Pathology·K MasuharaH Yoshikawa
Aug 22, 2001·American Journal of Physiology. Heart and Circulatory Physiology·B H PannenK K Geiger

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