[Pathomorphologic findings following intensive therapy].

Abstract

Based on autopsy findings in 301 adults who had died after intensive care, different patterns of single or multiple organ damage were identified. Signs of septicemia and/or exudative-to-fibrosing alveolitis (EFA) of the lungs, the prominent cause of the adult respiratory distress syndrome (ARDS), were recognized in 89 cases. Severe, progressive EFA, which appears to ensue mainly from continuing damage to alveolar walls, consequent fibroblast proliferation and so-called atelectatic induration (collapsed alveoli forming single thick septa), was registered only in individuals who had undergone long-term intensive care. The latter was necessitated in various severe conditions of which abdominal disease was the most important. Systemic disorders, such as hemorrhagic diathesis and multiple organ damage ("multiple organ failure"), showed a close correlation with septicemia. Infections with gram-negative bacteria appear to play a special role in such processes. Morphologically, these cases were characterized by multiple organ/system damage, e.g., in order of frequency, partial necrosis of renal proximal tubules, followed by signs of regeneration; jaundice; splenitis; lobular pneumonia; centrolobular-to-zonal liver necrosis, in part combined with cholestasis; petechial and/or extended hemorrhage; and others. This complex pattern contrasted strongly with findings in individuals who had been admitted to intensive care because of e.g. a cardiovascular incident: in this latter group (125 cases) intensive care was usually of short duration, progressive EFA was largely absent, signs of septicemia were exceptional, and multiple organ/system damage was rare. The group with polytraumatism (28 cases) exhibited a pattern of organ damage intermediate between (a) and (b).