title: Increased colorectal permeability in patients with severe sepsis and septic shock.
abstract: OBJECTIVE
  To develop a method for the assessment of colorectal permeability in septic patients.
  
  
  METHODS
  Observational study in ICUs at two university hospitals.
  
  
  METHODS
  Nine patients with septic shock and abdominal focus of infection, 7 with severe sepsis and pulmonary focus and 8 healthy subjects.
  
  
  RESULTS
  Colorectal permeability was assessed as the initial appearance rate of (99m)Tc-DTPA in plasma after instillation into the rectal lumen and as the cumulative systemic recovery at 1h. To calculate the latter, volume of distribution and renal clearance of (99m)Tc-DTPA was estimated by an i.v. bolus of (51)Cr-EDTA. The initial rate of permeability was increased in patients with septic shock and severe sepsis compared with controls [29.0 (3.7-83.3), 20.6 (3.6-65.5) and 6.0 (2.2-9.6)cpm ml(-1)min(-1), respectively, p<0.05)] with a positive linear trend (r (2)=0.27, p=0.01) and correlated to L-lactate concentrations in the rectal lumen (r (2)=0.39, p<0.05). The cumulative permeability was also increased in patients with septic shock and severe sepsis compared with controls [2.07 (0.05-15.7), 0.32 (0.01-1.2) and 0.03 (0.01-0.06) per thousand, respectively, p<0.01] and correlated to the initial permeability rate (r (2)=0.26, p=0.01).
  
  
  CONCLUSIONS
  In septic patients, the systemic recovery of a luminally applied marker of paracellular permeability was increased and related to the luminal concentrations of L-lactate and possibly to disease severity. This suggests that the assessment of colorectal permeability by systemic recovery of (99m)Tc-DTPA is valid and that metabolic dysfunction of the mucosa contributes to increased permeability of the large bowel in patients with severe sepsis and septic shock.
authors.affiliation: Department of Anaesthesia and Intensive Care, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Vibeke L
authors.initials: VL
authors.lastname: Jørgensen
authors.forename: Steen L
authors.initials: SL
authors.lastname: Nielsen
authors.forename: Kurt
authors.initials: K
authors.lastname: Espersen
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D007420:Intestine, Large / Q000378:metabolism*; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010539:Permeability; D018805:Sepsis / Q000503:physiopathology*; D012772:Shock, Septic / Q000503:physiopathology*; D016284:Technetium Tc 99m Pentetate
chemical_list: D019344:Lactic Acid; D016284:Technetium Tc 99m Pentetate