Microvascular permeability during experimental human endotoxemia: an open intervention study.
BACKGROUND
Septic shock is associated with increased microvascular permeability. As a model for study of the pathophysiology of sepsis, endotoxin administration to humans has facilitated research into inflammation, coagulation and cardiovascular effects. The present study was undertaken to determine whether endotoxin administration to human volunteers can be used as a model to study the sepsis-associated increase in microvascular permeability.


METHODS
In an open intervention study conducted in a university medical centre, 16 healthy volunteers were evaluated in the research unit of the intensive care unit. Eight were administered endotoxin intravenously (2 ng/kg Escherichia coli O113) and eight served as control individuals. Microvascular permeability was assessed before and 5 hours after the administration of endotoxin (n = 8) or placebo (n = 8) by three different methods: transcapillary escape rate of I(125)-albumin; venous occlusion strain-gauge plethysmography to determine the filtration capacity; and bioelectrical impedance analysis to determine the extracellular and total body water.


RESULTS
Administration of endotoxin resulted in the expected increases in proinflammatory cytokines, temperature, flu-like symptoms and cardiovascular changes. All changes were significantly different from those in the control group. In the endotoxin group all microvascular permeability parameters remained unchanged from baseline: transcapillary escape rate of I(125)-albumin changed from 7.2 +/- 0.6 to 7.7 +/- 0.9%/hour; filtration capacity changed from 5.0 +/- 0.3 to 4.2 +/- 0.4 ml/min per 100 ml mmHg x 10(-3); and extracellular/total body water changed from 0.42 +/- 0.01 to 0.40 +/- 0.01 l/l (all differences not significant).


CONCLUSIONS
Although experimental human endotoxaemia is frequently used as a model to study sepsis-associated pathophysiology, an endotoxin-induced increase in microvascular permeability in vivo could not be detected using three different methods. Endotoxin administration to human volunteers is not suitable as a model in which to study changes in microvascular permeability.
van Eijk
Lucas T G J
LT
Department of Intensive Care Medicine, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands. l.vaneijk@aig.umcn.nl
Pickkers
Peter
P
Smits
Paul
P
van den Broek
Wim
W
Bouw
Martijn P W J M
MP
van der Hoeven
Johannes G
JG
D000328:Adult; D001834:Body Water; D002199:Capillary Permeability; D003627:Data Interpretation, Statistical; D017097:Electric Impedance; D019446:Endotoxemia / Q000503:physiopathology; D004731:Endotoxins / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008833:Microcirculation; D010991:Plethysmography; D018805:Sepsis / Q000503:physiopathology*; D013997:Time Factors
D004731:Endotoxins