Plasma kallikrein-kinin system in patients with uncomplicated sepsis and septic shock--comparison with cardiogenic shock.

Alterations of the kallikrein-kinin system consistent with activation and increased consumption have been reported in septic patients and it has been suggested that this activation could contribute to the development of septic shock. The aim of this work was to confirm these alterations in septic patients and to investigate the possible existence of similar changes in subjects developing cardiogenic shock secondary to myocardial infarction as a model of non septic shock. Patients with septic shock, especially in fatal cases, showed a highly significant decrease in levels of factor XII, prekallikrein, high molecular weight kininogen (HMW-kininogen), alpha 2-macroglobulin (alpha 2-M) and antithrombin III (AT-III). C1-esterase inhibitor (C1-INH) activity was increased in uncomplicated sepsis but came back to normal or was slightly decreased in septic shock. Components and inhibitors of the kallikrein-kinin system were within normal limits in patients with cardiogenic shock. Our findings support the idea of a contribution of the kallikrein-kinin system to the development of septic shock though this system does not seem to play a significant role in the pathogenesis of cardiogenic shock or seem to be altered as a consequence of it.

A selective ventilation distribution circuit (S.V.D.C).

A circuit for selective ventilation distribution (S.V.D.C.) is described. The use of the circuit is illustrated with five cases in which it was used. S.V.D.C. allowed: 1) Measurement of individual lung tidal volumes and pressures during the respiratory cycle. 2) Adjustment of the tidal volumes of both lungs in the most appropriate way for the patient. 3) Application of different degrees of PEEP to each lung. The circuit is easily built and managed, the patient is connected to it by a double lumen endotracheal tube (Carlens tube); the circuit requires only one respirator.

[Shock. Antioxidant immunologico-therapeutic replacement]. / Consideraciones acerca del shock. Substitución inmunológica-terapéutica antioxidante.

Shock is a specific reaction to a non specific severe injury. The organic reaction is a biphasic (excitation/depression) threefold response: haemodynamic, hemostatic and immunologic. The physiopathology is related with changes produced by injury on macrophages, neutrophils, platelets and endothelial cells. The release of enzymes and certain vasoactive compounds enhance activation of neutrophils, which produce great amounts of free oxygen radicals. Therapy must be basically substitutive, including immunologic substitution. Therapeutic trends are based on the use of substances which can avoid the overproduction or nocive effects of free oxygen radicals.

[Separate lung ventilation circuit]. / Circuit de ventilation à poumons séparés.

A description of a selective ventilation distribution circuit (S.V.D.C.). The use of this circuit is illustrated by the description of 5 cases where the following were applied: 1 - the measurement of tidal volume of pressures for each lung during the respiratory cycle; 2 - regulation of tidal volumes to be as appropriate as possible for the patient; 3 - the application of different degrees of PEEP for each lung. This circuit is easy to construct and manipulate. It is connected to the patient via a double lumen endotracheal tube (Carlens) and uses only one respiratory.