PLASMA ENDOTOXIN AND CYTOKINE CONCENTRATIONS IN PATIENTS WITH HEMORRHAGIC-SHOCK

Objectives: The roles of cytokines and endotoxin in hemorrhagic shock, particularly the translocation of endotoxin and bacteria during hemorrhagic shock, were investigated. Design: Prospective study. Setting: Critical care and emergency center of a university hospital. Patients: Twenty-nine patients with hemorrhagic shock and 20 healthy controls. Interventions: Serial blood samples were collected from both study and control patients. Standard resuscitation techniques were used. Measurements and Main Results: Plasma levels of endotoxin and various cytokines were determined repeatedly during hemorrhagic shock. Endotoxin was measured using an endotoxin-specific assay in addition to a new perchloric acid method for pretreatment of plasma. Cytokines were measured by commercial enzyme-linked immunosorbent assays. Plasma endotoxin concentrations remained within the normal range for 7 days after admission. Although levels of tumor necrosis factor-alpha and several interleukins increased slightly in some patients, these cytokines did not reach the levels seen in septic shock. Conclusion: Translocation of bacteria or endotoxin from the gastrointestinal tract into the bloodstream has been noted in animal experiments; however, translocation was not detected in our patients with hemorrhagic shock.