TRANSLOCATION - INCIDENTAL PHENOMENON OR TRUE PATHOLOGY

Objective This study was conducted to determine if reduction of early postburn endotoxemia influences the cytokine cascade, clinical manifes tations of sepsis, and mortality rate. Summary Background Data Translo cational endotoxemia has been demonstrated postburn in animals and hum ans. 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 de monstrated. Methods In a prospective, randomized study, 76 burn patien ts were given polymyxin intravenously or served as control subjects. P olymyxin B was given intravenously for 1 week postburn in doses design ed to neutralize circulating endotoxemia. Results In the polymyxin gro up, there was a statistically significant reduction in the plasma endo toxin concentration. There was, however, no reduction in the sepsis sc ore or the interleukin-6 levels, and no differences in mortality rates were seen between the two groups. Conclusions Early postburn transloc ational 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 ca used by cytokine induction from the injury and is unaffected by a redu ction in the plasma endotoxin concentration.