CHARACTERISTICS OF THORACIC-DUCT LYMPH IN MULTIPLE ORGAN DYSFUNCTION SYNDROME

Objective: To investigate the presence of endotoxin, bacteria, and pot ential humoral and cellular mediators in thoracic duct lymph and perip heral blood in patients with severe refractory multiple organ dysfunct ion. Design: Convenience sample. Setting: General intensive care unit of a university hospital. Patients: Two men and 2 women were studied a fter a mean of 7.25 days (range, 6-9 days) of multiple organ dysfuncti on syndrome. The primary injury was thoracic in 1 patient and abdomina l in 3 patients. Intervention: The thoracic duct was cannulated with a 7F catheter and samples of lymph and peripheral blood were obtained. Main Outcome Measures: Simultaneous lymph and serum levels of lipopoly saccharide, tumor necrosis factor alpha, interleukin-1 beta, and inter leukin-6, and activation markers on T lymphocytes. Results: Lipopolysa ccharide and cytokine levels were low in lymph and serum, except for a mean lymph-to-serum ratio of 53.4 for interleukin-1 beta. There was p henotypical evidence of intense polyclonal T-lymphocyte activation in both lymph and peripheral blood with increased lymph-to-peripheral blo od ratios. Increased percentages in lymph of CD45RA+CD45RO+lymphocytes were observed. In 1 patient, Proteus mirabilis grew simultaneously in lymph, pancreatic necrosis fluid, and a central venous catheter tip. All simultaneous blood cultures were negative. Conclusions: Our result s provide evidence of the participation of the gut-associated lymphati c tissue in the pathogenesis of the multiple organ dysfunction syndrom e, suggesting that T-cell activation and cytokine production occur at the gut level. Future studies are needed to confirm and extend our fin dings.