What is Sepsis?  Lung Origin Theory

      
       

 

          
       

Generations of physicians have been perplexed by the development of multi-organ failure in patients admitted to intensive care with pneumonia or other primary lung injury. Traditional teaching was that the blood-lung interface served as a platform for bacterial invasion of the body. Recent research however has led to an alternate and frightening possibility: it is the use of mechanical ventilation which is the motor of the systemic inflammatory response. How can this be? There is compelling evidence that mechanical ventilation with large tidal volumes is associated with higher mortality (23). We have suspected since the seminal work of Webb and Tierney (24)which proposed that phasic mechanical ventilation can damage the lungs. It has been suggested that cytokines released as a consequence of ventilator induced lung injury may have adverse effects at distant organs (25). This hypothesis was confirmed from data in the NIH-ARDS trial (23). Blood samples were obtained from 204 of the first 234 patients for measurement of plasma interleukin-6 concentration. Levels of this cytokine were significantly higher in the high stretch (tidal volume 10-12ml/kg) compared with the low stretch (tidal volume 5-6ml/kg) group. In addition to lower mortality, this group had a significantly lower incidence of non pulmonary organ injury.

It is clear then that medical intervention can be a significant factor in the development of systemic sepsis, whether it is due to ventilator induced organ injury, line sepsis, parenteral nutrition, gut mucosal atrophy, wound infection or nosocomial pneumonia (associated with endotracheal intubation).

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References

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THIS TUTORIAL BY PATRICK NELIGAN MD, UNIVERSITY OF PENNSYLVANIA

        
       

 

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