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- IRMS - Nicolae Testemitanu SUMPh
- 1. COLECȚIA INSTITUȚIONALĂ
- MedEspera: International Medical Congress for Students and Young Doctors
- MedEspera 2014
Please use this identifier to cite or link to this item:
http://hdl.handle.net/20.500.12710/18424
Title: | Fighting the multi organ failure |
Authors: | Ben-Tsrooya, Idan |
Issue Date: | 2014 |
Publisher: | Ministry of Health of the Republic of Moldova, State Medical and Pharmaceutical University Nicolae Testemitanu, Medical Students and Residents Association |
Citation: | BEN-TSROOYA, Idan. Fighting the multi organ failure. In: MedEspera: the 5th Internat. Medical Congress for Students and Young Doctors: abstract book. Chișinău: S. n., 2014, pp. 166-167. |
Abstract: | Introduction: Multiple organ failure is the commonest cause of death in the intensive care unit
setting. There are numerous precipitating factors including sepsis, trauma and pancreatitis. The resulting
tissue hypoxia, exaggerated inflammatory response and generation of free oxygen radicals leads to tissue
damage and organ dysfunction. No definitive treatment exists despite considerable efforts to find a 'magic
bullet’. Management still revolves around support of organ function and prevention of iatrogenic
complications until recovery occurs. An increasing emphasis is being placed on prevention of organ
dysfunction, including maintenance of tissue oxygenation, nutrition and infection control. Multiple organ
failure (MOF) is the commonest cause of death in the intensive care unit (ICU). A clinical assessment of a
high likelihood of irreversible organ failure, particularly when multiple organs are involved, is the usual
factor prompting a decision to withdraw treatment or not to add further therapy. Sepsis is one precipitating
factor for MOF; numerous other causes of tissue damage are well recognized, e.g. trauma, burns and
pancreatitis. No definitive treatment exists and controversy surrounds many aspects of the management of
MOF. Problems include (i) a shortage of major multi-center, controlled studies in a well-defined patient
population (other than immunotherapy trials which are often of flawed design), (ii) an inclination to use
unproved interventions,(iii) over-extrapolation of data from laboratory studies,(iv) an often uncritical
acceptance of simplified, schematic representations of inflammatory mechanisms, (v) variable disease
syndrome definitions and (vi) diagnostic imprecision. The above contribute to the current lack of
hardened-fast rules regarding patient management; instead, there are a number of generally accepted
guidelines which still provide considerable scope for treatment variability. Examples of current grey areas
include selective gut decontamination, extracorporeal respiratory support and prophylaxis against stressulcer-related bleeding. There is also the widespread, though as yet unproven and unlicensed, use of nitric
oxide inhalation in acute lung injury, and the quest for a single ‘magic bullet’ to ameliorate the
generalized, exaggerated inflammatory response associated with severe sepsis. In the case of the strongly
promoted concept of ‘supranonnalizing’ hemodynamic parameters in the critically ill patient, whereby
elevated values of cardiac output, oxygen delivery and oxygen consumption were striven for, it was
several years before this approach was shown to be ineffective. Nevertheless, and despite the above
caveats, there has been progress in several areas. A better, though still incomplete, insight is being gained
into the pathophysiological mechanisms underlying the exaggerated inflammatory response that
frequently underlies MOF. There is a greater appreciation of the need to prevent organ dysfunction by
optimizing the circulation and avoidance or rapid correction of tissue hypoxia in high-risk patients. There
is are cognition of the importance of standard definitions, for example sepsis, the systemic inflammatory
response syndrome (SIRS), the multiple organ dysfunction syndrome (MODS) , the acute respiratory
distress syndrome (ARDS) and acute lung injury. There is also a recognized need to improve the
description of organ dysfunction. In addition, general advances and the increasing availability of intensive
care, superior ‘whole body’ organ suppoit, appropriate infection control, nutrition and pressure area care,
and avoidance of iatrogenic pulmonary barotrauma, have all contributed to improvements in outcome.
Objective: To determine whether translocation of bacteria or endotoxin occurred into the
thoracic duct in patients with multiple organ failure (M OF) is take active role in MOF.
Methods: 1. Meta-analysis of 156 patients from retrospective - preview date base of patients
in MOF. 2. The thoracic duct was drained for 5 days in patients with MOF caused either by
generalized fecal peritonitis (n = 4) or by an event without clinical and microbiologic evidence of
infection (n = 4). Patients without MOF who were undergoing a transthoracic esophageal resection
served as controls. In lymph and blood, concentrations of endotoxin, proinflammatory cytokines,
and anti-inflammtory cytokines were measured.
Experimental data: Description - in heart of Mousses, was examined the function of heart
(in vitro), in 3 state: 1. Normal without intervention. (Control group). 2. With lymph of MOF state.
3. With MOF state + thoracic duct ligation.
Conclusion: This meta-analysis study provides evidence that translocation (especially of
endotoxin) occurs into the thoracic duct. These data do support the concept that the thoracic duct is
a major route of bacterial translocation in patients with MOF. |
metadata.dc.relation.ispartof: | MedEspera: The 5th International Medical Congress for Students and Young Doctors, May 14-17, 2014, Chisinau, Republic of Moldova |
URI: | http://repository.usmf.md/handle/20.500.12710/18424 |
Appears in Collections: | MedEspera 2014
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