RESUMEN
Previous investigations of a treated model of hemorrhagic shock in the rat indicated the frequent occurrence of bacteremia that appeared to derive from the gut. This paper determines the incidence of bacteremia and endotoxemia during the acute shock period and compares this with similar observations in humans in varying degrees of shock. Studies in 26 rats indicated that bacteremia and endotoxemia was present in 50% and 87%, respectively, by the end of 2 hours at a mean arterial pressure of 30 mmHg. Observations in 50 patients admitted to the trauma unit showed that positive bacterial blood cultures were present in 56% when the admission systolic blood pressure was 80 mmHg or less (p less than 0.01 compared with either of the other groups). Endotoxemia was noticed in two such patients. Direct access of bacteria and endotoxin to the blood stream may occur during hemorrhagic or traumatic shock and is the probable cause of subsequent sepsis in traumatized patients when no other source is apparent.
Asunto(s)
Endotoxinas/sangre , Sepsis/etiología , Choque Hemorrágico/complicaciones , Choque Traumático/complicaciones , Enfermedad Aguda , Animales , Presión Sanguínea , Modelos Animales de Enfermedad , Humanos , Masculino , Ratas , Ratas Endogámicas , Sepsis/sangre , Sepsis/microbiología , Choque Hemorrágico/sangre , Choque Hemorrágico/microbiología , Choque Traumático/sangre , Choque Traumático/microbiología , Factores de TiempoRESUMEN
In a model of severe hemorrhagic shock in rats, blood culture findings became positive within 2 to 4 hours of shock. The organisms cultured were primarily gram-negative. To test the hypothesis that the gut was the source of the bacteria, E. coli labeled with carbon-14 oleic acid were fed to rats undergoing hemorrhagic shock. Their plasma was then assayed for carbon-14 activity. Seven of the 14 shocked animals demonstrated increased plasma carbon-14 activity during or after shock. The mortality rate was 100 percent 80 hours postshock, and all animals had E. coli on subsequent blood culture. The seven rats without increased plasma carbon-14 activity had a survival rate of 83 percent postshock. Sham-shocked animals did not exhibit plasma carbon-14 levels greater than the background levels. These data suggest that bacterial translocation occurs during hemorrhagic shock and that the gut is the source of the bacteremia seen during hemorrhagic shock.
Asunto(s)
Hipotensión/complicaciones , Intestinos/microbiología , Sepsis/etiología , Choque Hemorrágico/complicaciones , Animales , Transporte Biológico , Radioisótopos de Carbono , Infecciones por Escherichia coli/etiología , Masculino , Ratas , Ratas Endogámicas , Factores de TiempoRESUMEN
Hypothermia is a frequent complication of severe hemorrhagic shock and can complicate the treatment of trauma patients. The authors have investigated the effect of external warming on a treated model of hemorrhagic shock in rats. Their data show that externally heating the animal during the shock period decreases the animal's ability to withstand shock and increases intrashock and postshock mortality when compared to nonheated controls. The authors have also shown that nonheated animals that can retain body heat by passive retention can withstand increased shock time and have an increased postshock survival.