Intestinal Permeability After Severe Trauma and Hemorrhagic Shock Is Increased Without Relation to Septic Complications

doi:10.1001/archsurg.1993.01420160095016

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Vol. 128 No. 4, April 1993

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Intestinal Permeability After Severe Trauma and Hemorrhagic Shock Is Increased Without Relation to Septic Complications

Rudi M. H. Roumen, MD; Thijs Hendriks, PhD; Ron A. Wevers, PhD; R. Jan A. Goris, MD, PhD

Arch Surg. 1993;128(4):453-457.

Abstract

• After thermal injury, alterations in intestinal permeabilityhave been demonstrated and have correlated with subsequent infections.We measured intestinal permeability on the second day aftersevere trauma and hemorrhagic shock (ruptured abdominal aneurysm).The mean (±SD) lactulose-mannitol (L/M) excretion ratiowas 0.012±0.005 in seven healthy control subjects, 0.069±0.034in 11 severely traumatized patients, and 0.098±0.093in eight patients with aneurysm, indicating a significant increaseof intestinal permeability in both patient groups. No significantcorrelation was found between L/M ratios and age, severity ofinjury or shock, lactate levels on admission, APACHE (acutephysiology and chronic health evaluation) II score, daily pulmonarygas exchange parameters, or mean multiple organ failure scores.No difference in intestinal permeability between patients withand without subsequent infections could be demonstrated. In11 patients we looked for endotoxin in the systemic circulation.In six patients endotoxemia was present immediately after admissionand before the L/M test. However, during the L/M test and 1day afterward no circulating endotoxin was observed. The presentdata provide evidence for the hypothesis that increased intestinalpermeability and subsequent infectious complications are independentphenomena, frequently seen in patients after severe trauma orhemorrhagic shock.

(Arch Surg. 1993;128:453-457)

Author Affiliations

From the Department of General Surgery (Drs Roumen, Hendriks, and Goris) and the Laboratory of Pediatrics and Neurology (Dr Wevers), University Hospital Nijmegen (the Netherlands).

Footnotes

Accepted for publication December 6, 1992.

Reprints not available.

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