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Báo cáo y học: " Gut oxygenation in sepsis: still a matter of controversy"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Gut oxygenation in sepsis: still a matter of controversy? | Critical Care August 2002 Vol 6 No 4 Vallet Commentary Gut oxygenation in sepsis still a matter of controversy Benoit Vallet Professor Department of Anesthesiology and Intensive Care Medicine University Hospital of Lille Lille France Correspondence Benoit Vallet bvallet@chru-lille.fr Published online 31 May 2002 Critical Care 2002 6 282-283 This article is online at http ccforum.com content 6 4 282 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Part of Stephan Jakob s exhaustive review paper in the present issue of Critical Care deals with the notion that intestinal cellular energetics are deranged in sepsis in terms not only of inadequate tissue perfusion but also of impaired mitochondrial respiration and or coupling i.e. organ dysfunction in sepsis may occur as a result of cytopathic hypoxia . This suggests that efforts to improve outcome in septic patients by manipulating systemic oxygen delivery and regional blood flow are doomed to failure. That suggestion remains largely speculative and experimental and clinical results presented here consistently demonstrate that there is still a place for treatment of abnormal perfusion in the context of early severe sepsis and septic shock. Keywords cytopathic hypoxia haemodynamics oxygen delivery sepsis shock In his review paper published in the present issue of Critical Care Stephan Jakob 1 deals with the difficult and broad topic of splanchnic ischaemia in critical care. The presentation is exhaustive including the still controversial issue of inadequate gastrointestinal flow in septic states. As mentioned in that review several lines of evidence support the notion that cellular energetics are deranged in sepsis in terms not only of inadequate tissue perfusion but also of impaired mitochondrial respiration and or coupling i.e. organ dysfunction in sepsis may occur as a result of cytopathic hypoxia 2 . If this is correct then the therapeutic implications might be enormous. It would imply that