Translocation. Incidental phenomenon or true pathology?
OBJECTIVE
This study was conducted to determine if reduction of early postburn endotoxemia influences the cytokine cascade, clinical manifestations of sepsis, and mortality rate.


BACKGROUND
Translocational endotoxemia has been demonstrated postburn in animals and humans. Endotoxin is known to induce the cytokine cascade, which leads to the clinical manifestations of sepsis. Whether reduction of postburn endotoxemia could influence the induction of cytokines has not been demonstrated.


METHODS
In a prospective, randomized study, 76 burn patients were given polymyxin intravenously or served as control subjects. Polymyxin B was given intravenously for 1 week postburn in doses designed to neutralize circulating endotoxemia.


RESULTS
In the polymyxin group, there was a statistically significant reduction in the plasma endotoxin concentration. There was, however, no reduction in the sepsis score or the interleukin-6 levels, and no differences in mortality rates were seen between the two groups.


CONCLUSIONS
Early postburn translocational endotoxemia can be treated with anti-endotoxin agents such as polymyxin B. This, however, does not influence the cytokine cascade or the mortality rate. The systemic inflammatory response syndrome is caused by cytokine induction from the injury and is unaffected by a reduction in the plasma endotoxin concentration.
Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
A M
AM
Munster
M
M
Smith-Meek
C
C
Dickerson
R A
RA
Winchurch
D000328:Adult; D002056:Burns / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D004731:Endotoxins / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011446:Prospective Studies; D015996:Survival Rate; D014115:Toxemia / Q000097:blood / Q000401:mortality / Q000503:physiopathology* / Q000517:prevention & control; D014946:Wound Infection / Q000097:blood / Q000401:mortality / Q000503:physiopathology* / Q000517:prevention & control
D004731:Endotoxins; D015850:Interleukin-6; D011112:Polymyxin B