Chest
ReviewOrgan Interactions in the Adult Respiratory Distress Syndrome during Sepsis: Role of the Liver in Host Defense
Section snippets
Control of Systemic Endotoxemia and Bacteremia: Role of Hepatic Mononuclear (Kupffer) Cells
Circulating Gram-negative bacterial endotoxin has been extensively implicated in the mediation of early pathogenetic events relevant to sepsis-induced ARDS with multiple systems organ failure. There are a variety of mechanisms, including direct cytotoxic effects of endotoxin on endothelial cells, induction of endothelial cell surface factors that promote neutrophil adherence, activation of phagocytes, “priming” of phagocytes by endotoxin to become hyperactivated in response to other stimuli,
CONCLUSIONS
The multistage evolution of sepsis-induced ARDS with multiple systems organ failure involves organ system interactions which play intrinsic roles in the integrated host response to infection. Interrelations between hepatic and pulmonary function can potentially exacerbate ARDS by several clearly defined pathways because the liver plays a pivotal role as a regulator of systemic host defense. Patients with severe hepatic dysfunction appear to represent a group at particularly high risk for
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Supported in part by grants from the VA Medical Research Service, the Department of Anesthesiology/Critical Care Medicine, and HL 32725.