Plasma endotoxin and cytokine concentrations in patients with hemorrhagic shock

Objectives The roles of cytokines and endotoxin in hemorrhagic shock, particularly the translocation of endotoxin and bacteria during hemorrhagic shock, were investigated. Design Prospective study. Setting Critical care and emergency center of a university hospital. Patients Twenty-nine patients with hemorrhagic shock and 20 healthy controls. Interventions Serial blood samples were collected from both study and control patients. Standard resuscitation techniques were used. Measurements and main results Plasma levels of endotoxin and various cytokines were determined repeatedly during hemorrhagic shock. Endotoxin was measured using an endotoxin-specific assay in addition to a new perchloric acid method for pretreatment of plasma. Cytokines were measured by commercial enzyme-linked immunosorbent assays. Plasma endotoxin concentrations remained within the normal range for 7 days after admission. Although levels of tumor necrosis factor-alpha and several interleukins increased slightly in some patients, these cytokines did not reach the levels seen in septic shock. Conclusions Translocation of bacteria or endotoxin from the gastrointestinal tract into the bloodstream has been noted in animal experiments; however, translocation was not detected in our patients with hemorrhagic shock.