Update in Intensive Care and Emergency Medicine. Edited by J.-L.Vincent

Transcription

1 18 Update in Intensive Care and Emergency Medicine Edited by J.-L.Vincent

2 K. Reinhart K. Eyrich C. Sprung (Eds.) Sepsis Current Perspectives in Pathophysiology and Therapy With 109 Figures and 56 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest

3 Series Editor Prof. Dr. Jean-Louis Vincent Clinical Director, Department of Intensive Care Erasme University Hospital Route de Lennik 808, 1070 Brussels, Belgium Volume Editors Prof. Dr. Konrad Reinhart Direktor der Klinik fur Anasthesiologie und Intensivtherapie Klinikum der Friedrich Schiller-Universitat Jena BachstraBe 18,07740 Jena, FRG Prof. Dr. Klaus Eyrich Klinik fur Anasthesiologie und operative Intensivmedizin Universitatsklinikum Steglitz der FU Berlin Hindenburgdamm 30, Berlin, FRG Prof. Dr. Charles Sprung Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University, Medical Center P. O. Box 12000,91120 Jerusalem, Israel ISBN-13: e-isbn-13: : / This work is subject to copyright. All rigths are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9,1965, in its current version, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. Springer-Verlag Berlin Heidelberg 1994 Softcover reprint of the hardcover Ist edition 1994 The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typesetting: Zechnersche Buchdruckerei, Speyer 19/ Printed on acid-free paper

4 Preface Sepsis is still the leading cause of death in surgical and general intensive care units. Although our knowledge of this complex syndrome has increased in recent years, it is still far from complete. New therapeutic approaches have been developed. Some did not fullfill the high expectations for their use in clinical practice; others are still under clinical evaluation. It is the aim of this monograph to offer basic information on the etiology, definition, pathophysiology, prevention and therapy of sepsis and septic shock to both the clinician and the scientist. We believe that it presents an extensive overview that may help the clinician to better understand and treat sepsis and septic shock. We also hope that this work will give some directions for future research both in the clinical field as well as the laboratory. Jena, Berlin, Jerusalem, February 1994 K.Reinhart K. Eyrich C.Sprung

5 Table of Contents I. Definition/Prognosis Sepsis and Septic Shock: Update on Definitions (Jo-L. Vincent) Clinical Manifestations and Prognostic Indicators in Sepsis (R. C. Bone) What Determines Prognosis in Sepsis? Evidence for a Comprehensive Individual Patient Risk Assessment Approach to the Design and Analysis of Clinical Trials (W.A. Knaus, D. P. Wagner, F. E. Harrell, Jr. and E.A.Draper) A Scoring System for Multiple Organ Dysfunction Syndrome (Jo C. Marshall) II. Pathogenesis Endotoxemia and Sepsis: Important Roles for Lipopolysaccharide Binding Protein and CD14 in Endotoxin Signal Transduction (K. F. Bruin, M.A.M. von der M6hlen and S. Jo H. van Deventer) o. 53 The Function and Potential Therapeutic Value of Lipopolysaccharide Binding Protein During Gram Negative Sepsis: Recombinant Expression and Promoter Studies (R. R. Schuman, N. Lamping, C. Kirschning, H. Po Knopf and F. Herrmann) 0 391

6 VIII Table of Contents Bacterial Exotoxins and Sepsis (w. Seeger, H. Schiitte, F. Grimminger, N. Suttorp and B. Bhakdi) Bacterial Translocation: Myth versus Reality (M. D. Pasquale, M. D. Cipolle and F. B. Cerra) Tumor Necrosis Factor and Other Cytokines in Septic Syndrome (B. Beutler) Role of Oxygen Free Radicals in the Pathophysiology of Sepsis (M. Kretzschmar) 122 ill. Pathophysiology Cardiocirculation in Sepsis (F. Bloos and W. J. Sibbald) A Current View of Oxygen Supply Dependency (S. M. Cain) 150 Sepsis and Nutritional Blood Flow (M. D. Menger, B. Vollmar and K. Messmer) Endothelial Cell Function in the Critically III (J. -L. Vincent, J. C. Preiser, G. Friedman and H. Zhang) Sepsis and Cellular Metabolism (0. Gutierrez) 181 IV. Monitoring Monitoring of O 2 Transport and Tissue Oxygenation in Septic Shock (K. Reinhart, L. Hannemann, A. Meier-Hellmann and M. Specht) 193 v. Therapy Sepsis-Related Problems in Pediatric Patients (J. A. Hazelzet and R. de Groot) 217

7 Table of Contents IX Definitions and Therapy of Sepsis (R. C. Bone) Role of Surgical Intervention in the Prevention and Therapy of Sepsis (W Teichmann, B. Herbig and M. Weidner) 239 Antibacterial Treatment of Sepsis (D. Adam and B. Gerlach) Diagnostic and Therapeutic Approach in Invasive Fungal Infections of Intensive Care Unit Patients (M. Petri, H. Lode and T. Schaberg) Fluid Therapy in Sepsis (WI. Sibbald) Influence of Catecholamines on Regional Perfusion and Tissue Oxygenation in Septic Shock Patients (A. Meier-Hellmann and K. Reinhart) Metabolic Changes in Sepsis - Can the Host Response be Influenced Metabolically? (M. Georgieff, T. Schricker and B. Kugler) 292 VI. New Therapeutic Approaches Is there a Place for Monoclonal Antibodies Against Endotoxin in the Therapy of Sepsis? (L. Eidelman and C. L. Sprung) 307 Endotoxin in Septic Shock (Z.M.N. Quezada, C.Natanson and WD.Hoffman) 314 Tumour Necrosis Factor as a Therapeutic Target in Sepsis (S. Sriskandan and I. Cohen) 337 Tumor Necrosis Factor-Neutralization with a Specific Monoclonal Antibody (M. Kluge and M. Kaul)

8 X Table of Contents Cardiovascular Effects of Repeated Administration of the F(ab')z Fragment of an Anti-tumor Necrosis Factor-a Monoclonal Antibody in Patients with Severe Sepsis (P. Boekstegers, S. WeidenhOfer, R. Zell, G. Pilz, E. Holler, T Kapsner, M. Kaul, f. Kempeni and K. Werdan). 357 Modulating Effects of Pentoxifylline on Cytokine Release Syndromes (F U. Schade and P. Zabel) The Treatment of Sepsis with Interleukin-1 Receptor Antagonist (s. M. Opal, C. f. Fisher, fr. and f. Pribble).., The Function and Potential Therapeutic Value of Lipopolysaccharide Binding Protein During Gram Negative Sepsis: Recombinant Expression and Promoter Studies (R. R. Schuman, N. Lamping, C. Kirschning, H. P. Knopf and F Herrmann). 391 Platelet-Activating Factor: Pathophysiological Changes and Therapeutic Implications in Sepsis (f. F Dhainaut, f. P. Mira and L. Fierobe) Potential of Oxyradical Scavengers in the Therapy of Sepsis (f.f. Zimmerman) 414 N-Acetylcysteine in Sepsis (c. Spies and K. Reinhart) Immunoaugmentation: A Contribution to Prophylaxis and Treatment of Sepsis? (E. Faist, A. Markewitz, R. Maier and S. Lang) What Is Certain in the Treatment with Immunoglobulins? (H. G. Kress) 449 Arachidonic Acid Metabolism in Sepsis: What is the Role of Cyclooxygenase Inhibition? (G.R.Bernard) 464

9 Table of Contents XI Improvement of Monocyte Function - A New Therapeutic Approach? (W. D. Docke, U. Syrbe, A. Meinecke, C. Platzer, A. Makki, K. Asadullah, C. Klug, H. Zuckermann, P. Reinke, H.Brunner, R. vonbaehr and H.D. Volk). 473 From Localized Angioedema to Generalized Capillary Leak Syndrome (B. Eisele and U. De/vos) 501 Potential for Gene Therapy in the Treatment of Sepsis (K. L. Brigham, A. E. Canonico, J. T Conary, B. 0. Meyrick and H. Schreier) 528 VII. Specific Therapeutic Aspects Step-by-Step Treatment of Acute Respiratory Distress Syndrome (K. Lewandowski, R. Rossaint and K. J. Falke) Perfluorocarbons as an Alternative Respiratory Medium (A. S. TiitUncii and B. Lachmann) 549 Subject Index 565

10 List of Contributors Prof Dr. med. Dr. rer. nat. D.Adam Vorstand der Abteilung flir Antimikrobielle Therapie und Infektionsimmunologie Dr. von Haunersches Kinderspital der UniversitiH LindwurmstraBe Miinchen, FRG Prof G. R. Bernard, MD Division of Pulmonary and Critical Care Medicine Center for Lung Research Vanderbilt University Nashville, TN , USA Prof B. Beutler, MD Research Laboratories Howard Hughes Medical Institute 5353 Harry Hines Boulevard Dallas, TX , USA Dr. med. F. Bloos The Richard Ivey Critical Care Trauma Centre Victoria Hospital Corporation 375 South Street London, Ontario NGA 4G5, Canada Dr. med. P. Boekstegers Medizinische Klinik I Ludwig-Maximilians-Universitat Miinchen Klinikum GroBhadern Marchionistr Miinchen, FRG Prof R. C. Bone, MD The Medical College of Ohio, Toledo 3000 Arlington Avenue Toledo, OH , USA Prof K.L.Brigham, MD Center for Lung Research Department of Medicine Vanderbilt University School of Medicine Nashville, TN 37232, USA K.F.Bruin Department of Inflammation Research, AMC Hospital University of Amsterdam Medical Center Meibergdreef AZ Amsterdam, The Netherlands Prof s. M. Cain, MD, PhD Department of Physiology and Biophysics University of Alabama at Birmingham Birmingham, AL , USA Prof F. B. Cerra, MD Department of Surgery University of Minnesota 406 Harvard Street Southeast Minneapolis, MN 55455, USA Prof Dr. med. J. Cohen Director of the Department of Infectious Diseases & Bacteriology Hammersmith Hospital Du Cane Road London W12 ONN, UK

11 XIV List of Contributors Prof J. F Dhainaut, MD, PhD Chef de Service de Reanimation Cochin Port-Royal University Hospital 27, Rue du Faubourg Saint-Jacques Paris, France W.D.Docke Institut flir Medizinische Immunologie UniversiHltsklinikum Charite Humboldt-Universitat Schumannstr. 20/ Berlin, FRG L. Eidelman, MD Department of Anesthesiology and Critical Care/Medicine Hadassah Hebrew University, Medical Center PO Box Jerusalem, Israel Dr. med. B. Eisele SGE Therapeutika Klinische Forschung Thrombose & Intensivmedizin Behringwerke AG Postfach MarburglLahn, FRG Priv.-Doz. Dr. med. E. Faist Chirurgische Klinik und Poliklinik Ludwig-Maxirnilians-Universitat Mtinchen Klinikum GroBhadern Postfach Miinchen, FRG Prof Dr. med. K.J.Falke Direktor der Klinik flir Anasthesiologie und operative Intensivmedizin Klinikum Rudolf Virchow der Freien Universitat Berlin Augustenburger Platz Berlin, FRG Prof Dr. med. M. Georgieff Geschaftsflihrender Direktor der Universitatsklinik flir Anasthesiologie Klinikum der Universitat Ulm Postfach UIm, FRG Prof G. Guiterrez, MD, PhD Pulmonary and Critical Care Medicine Division The University of Texas Medical School 6431 Fannin, MSMB Houston, TX 77030, USA J. A. Hazelzet, MD Dr. Molewaterplein GJ Rotterdam, The Netherlands Dr. med. M.Kaul Knoll AG Oncology/lmrnunology Postfach Ludwigshafen, FRG Dr. med. M. Kluge Knoll AG Oncology/lmrnunology Postfach Ludwigshafen, FRG Prof w.a. Knaus, MD Director, ICU Research Unit The George Washington University 2300 K Street, N.W. Washington DC 20037, USA Prof Dr. med. H. G. Kress Department of Anaesthesiology and Intensive Care Medicine University of Vienna (AKH) Wahringer Gtirtel Vienna, Austria Priv.-Doz. Dr. med. habit. M. Kretzschmar Klinik flir Anasthesiologie und Intensivtheraphie Klinikum der Friedrich-Schiller-Universitat Jena BachstraBe Jena, FRG Prof Dr. med. B. Lachmann Department of Anesthesiology Erasmus University Rotterdam Postbox DR Rotterdam, The Netherlands

12 List of Contributors XV Dr. med. K. Lewandowski Klinik fur Anasthesiologie und operative Intensivmedizin Klinikum Rudolf Virchow der Freien Universitat Berlin Augustenburger Platz Berlin, FRG Prof Dr. med. H. Lode Pneumologie I - Infektiologie und Immunologie Krankenhaus Zehlendorf-Berlin Zum Heckeshorn Berlin, FRG J.C.Marshall, MD, FRCS(C), FACS General and Critical Care Surgery Toronto General Hospital 200 Elizabeth Street Eaton North Toronto, Ontario M5G 2C4, Canada Dr. med. A. Meier-Hellmann Klinik fur Anasthesiologie und operative Intensivmedizin Klinikum Steglitz der Freien Universitat Berlin Hindenburgdamm Berlin, FRG Priv.-Doz. Dr. med. M. D. Menger Direktor des Instituts fur Chirurgische Forschung Ludwig-Maximilians-Universitat Miinchen Klinikum GroBhadern MarchioninistraBe Miinchen, FRG C. Natanson, MD Critical Care Medicine Department National Institutes of Health 9000 Rockville Pike Bethesda, MD 20892, USA S. M. Opal, MD Infectious Disease Division Memorial Hospital of Rhode Island 111 Brewster Street Pawtucket, RI 02860, USA M. D. Pasquale, MD Department of Surgery University of Minnesota 406 Harvard Street Southeast Minneapolis, MN 55455, USA Dr. med. M. Petri Pneumologie I - Infektiologie und Immunologie Krankenhaus Zehlendorf-Berlin Zum Heckeshorn Berlin, FRG Z. M. N. Quezada, MD Critical Care Medicine Department National Institutes of Health 9000 Rockville Pike Bethesda, MD 20892, USA Prof Dr. med. K. Reinhart Direktor der Klinik fur Anasthesiologie und Intensivtherapie Klinikum der Friedrich-Schiller-Universitat Jena BachstraBe Jena, FRG Priv.-Doz. Dr. med. F. U. Schade Institut fur Experimentelle Biologie und Medizin Forschungsinstitut Borstel Parkallee Borstel, FRG Dr. med. R. R. Schumann Max-Delbriick-Centrum fur molekulare Medizin Robert-Rossle-StraBe Berlin, FRG Prof Dr. med. W. Seeger Medizinische Klinik I Medizinisches Zentrum fur Innere Medizin Klinikum der Justus-Liebig-Universitat GieBen KlinikstraBe GieBen, FRG Prof w.j. Sibbald, MD, FRCPC, FACP Coordinator, The Richard Ivey Critical Care Trauma Centre Victoria Hospital Corporation 375 South Street London, Ontario NGA 4G5, Canada

13 XVI List of Contributors Dr. med. C. Spies Klinik fur Anasthesiologie und operative Intensivmedizin Klinikum Steglitz der Freien Universitat Berlin Hindenburgdamm Berlin, FRO Ch. L. Sprung, MD, ID, FCCM Department of Anesthesiology and Critical CarelMedicine Hadassah Hebrew University, Medical Center PO Box Jerusalem, Israel S. Sriskandan, MD Department of Infectious Diseases & Bacteriology Hammersmith Hospital Du Cane Road London W12 ONN, UK Prof Dr. med. W. Teichmann Chefarzt der 1. Chirurg. Abteilung des Allgemeinen Krankenhauses Altona Paul-Ehrlich-StraBe Hamburg, FRO A. S. Tiltilncil, MD Department of Anesthesiology Erasmus University Rotterdam Postbox DR Rotterdam, The Netherlands S. I. H. van Deventer, MD Department of Inflammation Research, AMC Hospital University of Amsterdam Medical Center Meibergdreef AZ Amsterdam, The Netherlands Prof Dr. I.-L. Vincent Clinical Director, Department of Intensive Care Erasme University Hospital Route de Lennik Brussels, Belgium Prof Dr. med. R. von Baehr Oeschaftsfuhrender Direktor des Instituts fur Medizinische Immunologie Universitatsklinikum Charite Humboldt-Universitat Schumannstr. 20/ Berlin, FRO Prof Dr. med. K. Werdan Medizinische Klinik I Ludwig-Maximilians-U niversitat Miinchen Klinikum OroBhadern Marchionistr Miinchen, FRO I. I. Zimmermann, MD, PhD University of Wisconsin Children's Hospital 600 Highland Avenue Madison, WI , USA