Abstract
Septic morbidity associated with advanced surgical and medical treatments is unacceptably high, and so is the incidence of complications occurring in connection with acute emergencies such as severe trauma and severe acute pancreatitis. Only considering the US, it will annually affect approximately (app) 300 million (mill) of a population of almost one million inhabitants and cause the death of more than 200,000 patients, making sepsis the tenth most common cause of death in the US. Two major factors affect this, the lifestyle-associated increased weakness of the immune defense systems, but more than this the artificial environment associated with modern treatments such as mechanical ventilation, use of tubes, drains, intravascular lines, artificial nutrition and extensive use of synthetic chemical drugs, methods all known to reduce or eliminate the human microbiota and impair immune functions and increase systemic inflammation. Attempts to recondition the gut by the supply of microorganisms have sometimes shown remarkably good results, but too often failed. Many factors contribute to the lack of success: unsuitable choice of probiotic species, too low dose, but most importantly, this bio-ecological treatment has never been given the opportunity to be tried as an alternative treatment. Instead it has most often been applied as complementary to all the other treatments mentioned above, including antibiotic treatment. The supplemented lactic acid bacteria have most often been killed already before they have reached their targeted organs.
Highlights
A Pandemic of Critical IllnessAdvanced surgical and medical treatments, as well as medical and surgical emergencies, are, despite some breath-taking advances in medico-pharmaceutical and surgical treatment, still accompanied by an unacceptably high morbidity and mortality
Patients who develop severe septic complications are known to respond to physical and mental stress with an early exuberant acute, or chronic, super-inflammation, with signs of exaggerated and prolonged release of pro-inflammatory cytokines such as interleukin-6 (IL-6), acute phase proteins such as C-reactive protein, and plasminogen activator inhibitor 1 (PAI-1)—see [17]—a reaction strongly associated with subsequent severe exacerbation of disease, including acute respiratory distress syndrome (ARDS), and multiple organ failure (MOF)
Supplementation of probiotics will effectively prevent neutrophil infiltration of the lung and reduce the subsequent tissue destruction, as demonstrated in studies with inflammation induced by cecal ligation and puncture (CLP)
Summary
Advanced surgical and medical treatments, as well as medical and surgical emergencies, are, despite some breath-taking advances in medico-pharmaceutical and surgical treatment, still accompanied by an unacceptably high morbidity and mortality. Advanced surgery carries a high rate of septic morbidity and especially esophageal, pancreatic, and gastric procedures are known to represent great risk for the development of sepsis, but thoracic, adrenal, and hepatic procedures are those that have the highest sepsis-induced mortality [1,2]. It is documented in the literature that elderly patients, men, and nonwhites are the most likely to develop sepsis as a complication to surgical treatment [1,2]. Sepsis is by far the most common medical and surgical complication, and estimated only in the US to annually affect as many as 751,000 [4,5], and cause death of app 215,000 patients (29% of treated patients) [5], making sepsis the tenth most common cause of death in this country
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