Multiple system organ failure - Is mechanical ventilation a contributing factor?
Multiple system organ failure - Is mechanical ventilation a contributing factor?
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DOI：
10.1164/ajrccm.157.6.9709092
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发表时间：
1998-06-01
影响因子：
24.7
通讯作者：
Tremblay, LN
中科院分区：
文献类型：
--
作者：
Slutsky, AS;Tremblay, LN
重症监护医生面临的问题很少像多系统器官衰竭 (MSOF) 那样令人沮丧或难以处理。虽然确切的病因仍不清楚，但一个重要的特征是出现猖獗的全身炎症反应，这种反应在宿主控制机制的作用下持续存在且不减弱。无论是一次大规模的侮辱，还是一系列不太强烈的侮辱（即“两次打击”）似乎都是压倒个体先天调节机制所必需的。通常，肺是第一个衰竭的器官，导致开始（或继续）通气支持。尽管在一些患者中，可以识别出感染或炎症的诱发病灶，并且肺损伤只是全身过程的第一个临床明显表现，但仍有大量患者从呼吸衰竭进展为多系统器官衰竭的解释尚不清楚。在这个角度，我们探讨了这样的假设：机械通气可能在启动和/或 全身炎症反应的传播导致某些患者出现 MSOF。我们通过研究以下问题来解决这个问题：机械通气是否会引发或加剧肺损伤/炎症？肺损伤/炎症会导致全身炎症吗？是否有继发于机械通气的 MSOF 的证据？
Few problems facing the intensivist are as frustrating or as difficult to manage as multiple system organ failure (MSOF). While the precise etiology remains unknown, an integral feature is the development of a rampant systemic inflammatory response that persists unabated by host control mechanisms. Either a single massive insult, or a series of less intense insults (i.e., "two-hits") appear to be necessary to overwhelm the individuals innate regulatory mechanisms. Often the lung is the first organ to fail, leading to initiation (or continuation) of ventilatory support. Although in some patients a precipitating nidus of infection or inflammation is identifiable, and lung injury is simply the first clinically evident manifestation of a systemic process, there remain a large number of patients in whom the explanation for progression from respiratory failure to multiple system organ failure is unclear.In this Perspective, we explore the hypothesis that mechanical ventilation may play a pivotal (and hereto unrecognized) role in the initiation and/or propagation of a systemic inflammatory response leading to MSOF in certain patients. We address this issue by examining the following questions: Can mechanical ventilation initiate or exacerbate lung injury/inflammation? Can lung injury/inflammation lead to systemic inflammation? Is there evidence of MSOF secondary to mechanical ventilation?.