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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2009 | Review

Pathophysiology of the systemic inflammatory response after major accidental trauma

Authors: Anne Craveiro Brøchner, Palle Toft

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2009

Abstract

Background

The purpose of the present study was to describe the pathophysiology of the systemic inflammatory response after major trauma and the timing of final reconstructive surgery.

Methods

An unsystematic review of the medical literature was performed and articles pertaining to the inflammatory response to trauma were obtained. The literature selected was based on the preference and clinical expertise of authors.

Discussion

The inflammatory response consists of hormonal metabolic and immunological components and the extent correlates with the magnitude of the tissue injury. After trauma and uncomplicated surgery a delicate balance between pro- and anti-inflammatory mediators is observed. Trauma patients are, however, often exposed, not only to the trauma, but to several events in the form of initial surgery and later final reconstructive surgery. In this case immune paralysis associated with increased risk of infection might develop. The inflammatory response is normalized 3 weeks following trauma. It has been proposed that the final reconstructive surgery should be postponed until the inflammatory response is normalized. This statement is however not based on clinical trials.

Conclusion

Postponement of final reconstructive surgery until the inflammatory is normalized should be based on prospective randomized trials.

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Weissman C: The metabolic response to stress: An overview and uptake. Anesthesiology. 1990, 73 (2): 308-327. 10.1097/00000542-199008000-00020.CrossRefPubMed

Buckingham JC: Hypothalamo-pituitary responses to trauma. Br Med Bull. 1985, 41: 203-211.PubMed

Cannon WB: The emergency function of the adrenal medulla in pain and the major emotions. Am J Physiol. 1914, 33: 356-372.

Ni Choleain N, Redmond HP: Cell response to surgery. Arch Surg. 2006, 141: 1132-1140. 10.1001/archsurg.141.11.1132.CrossRef

Salo M: Effects of anaesthesia and surgery on the immune response. Acta Anaesthesiol Scand. 1992, 36: 201-220. 10.1111/j.1399-6576.1992.tb03452.x.CrossRefPubMed

Raju R, Bland KI, Chaudry IH: Estrogen: A novel therapeutic adjunct for the treatment of trauma-hemorrhage-induced immunological alterations. Mol Med. 2008, 14: 213-221.PubMedCentralPubMed

Jarrar D, Kuebler JF, Wang P, Bland KI Chaudry IH: DHEA: a novel adjunt for the treatment of male trauma patients. TRENDS in Mol Med. 2001, 7: 81-85. 10.1016/S1471-4914(01)01917-7.CrossRef

Mizushima Y, Wang P, Jarrar D, Cioffi WG, Bland KI, Chaudry IH: Estradiol administration after trauma-hemorrhage improves cardiovascular and hepatocellular functions in male animals. Ann Surg. 2000, 232: 673-679. 10.1097/00000658-200011000-00009.PubMedCentralCrossRefPubMed

May AK, Dossett LA, Norris PR, Hansen EN, Dorsett RC, Popovsky KA, Sawyer RG: Estradiol is associated with mortality in critically ill trauma and surgical patients. Crit Care Med. 2008, 36: 62-68. 10.1097/01.CCM.0000292015.16171.6D.PubMedCentralCrossRefPubMed

10.

Cuthbertson DP: Observations on the disturbances of metabolism produced by the injury to the limbs. Q J Med. 1932, 1: 233-244. [http://qjmed.oxfordjournals.org/cgi/content/citation/1/2/233]

11.

Bessey PQ, Jiang ZM, Johnson DJ, Smith RJ, Wilmore DW: Posttraumatic skeletal muscle proteolysis. The role of the hormonal environment. World J Surg. 1989, 13: 465-470. 10.1007/BF01660758.CrossRefPubMed

12.

Smith RM: Immunity, trauma and the elderly. Injury. 2007, 38: 1401-1404. 10.1016/j.injury.2007.09.013.CrossRefPubMed

13.

Russell JA, Ronco JJ, Lockhat D, Belzberg A, Kiess M, Dodek PM: Oxygen delivery and consumption and ventricular preload are greater in survivors than in nonsurvivors of the adult respiratory distress syndrome. Am Rev Respir Dis. 1990, 141: 659-65. Erratum in: Am Rev Respir Dis 142: 260CrossRefPubMed

14.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001, 345: 1368-77. 10.1056/NEJMoa010307.CrossRefPubMed

15.

Kohl BA, Deutschman CS: The inflammatory response to surgery and trauma. Curr Opin Crit Care. 2006, 12: 325-332. 10.1097/01.ccx.0000235210.85073.fc.CrossRefPubMed

16.

Hunt TK, Knighton DR, Thakral KK, Goodson WH, Andrews WS: Studies on inflammation and wound healing: angiogenesis and collagen synthesis stimulated in vivo by resident and activated wound macrophages. Surgery. 1984, 96: 48-54.PubMed

17.

Harris HE, Raucci A: Alarmin(g) news about danger: workshop on innate danger signals and HMBG1. EMBO rep. 2006, 7: 774-778.PubMedCentralPubMed

18.

Huber-Lang M, Huber-Lang M, Sarma JV, Zetoune FS, Rittirsch D, Neff TA, McGuire SR, Lambris JD, Warner RL, Flierl MA, Hoesel LM, Gebhard F, Younger JG, Drouin SM, Wetsel RA, Ward PA: Generation of C5a in the absence of C3: a new complement activation pathway. Nat Med. 2006, 12: 682-687. 10.1038/nm1419.CrossRefPubMed

19.

Krem MM, Di Cera E: Evolution of enzyme cascades from embryonic development to blood coagulation. Trends Biochem Sci. 2002, 27: 67-74. 10.1016/S0968-0004(01)02007-2.CrossRefPubMed

20.

Shatney CH, Benner C: Sequential serum complement (C3) and immunoglobulin levels in shock/trauma patients developing acute fulminant systemic sepsis. Circ Shock. 1985, 16: 9-17.PubMed

21.

Svoboda P, Kantorová I, Ochmann J: Dynamics of interleukin 1, 2, and 6 and tumor-necrosis factor alpha in multiple trauma patients. J Trauma. 1994, 36: 336-340. 10.1097/00005373-199403000-00009.CrossRefPubMed

22.

Ferguson KL, Taheri P, Rodriquez J, Tonapi V, Cardellio A, Dechert R: Tumor necrosis factor activity increases in the early response to trauma. Acd Emerg Med. 1997, 4: 1035-1040. 10.1111/j.1553-2712.1997.tb03676.x.CrossRef

23.

Dinarello CA: Biology of interleukin 1. FASEB J. 1988, 2: 108-115.PubMed

24.

Keel M, Ecknauer E, Stocker R, Ungethum U, Steckholzer U, Kenney J, Gallati H, Trentz O, Ertel W: Different pattern of local and systemic release of proinflammatory and anti-inflammatory mediators in severely injured patients with chest trauma. J Trauma. 1996, 40: 907-912. 10.1097/00005373-199606000-00008.CrossRefPubMed

25.

Lyons A, Kelly JL, Rodrick ML, Mannick JA, Lederer JA: Major injury induces increased production of interleukin-10 by cells of the immune system with a negative impact on resistance to infection. Ann Surg. 1997, 226: 450-458. 10.1097/00000658-199710000-00006.PubMedCentralCrossRefPubMed

26.

Nast-Kolb D, Waydhas C, Gippner-steppert C, Schneider I, Trupka A, Ruchholtz S, Zettl R, Schweiberer L, Jochum M: Indicators of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries. J Trauma. 1997, 42: 446-454. 10.1097/00005373-199703000-00012.CrossRefPubMed

27.

Tilg H, Trehu E, Atkins MB, Dinarello CA, Mier JW: Interleukin-6 (IL-6) as an anti-inflammatory cytokine: induction of circulating IL-1 receptor antagonist and soluble tumor necrosis factor receptor p55. Blood. 1994, 83: 113-118.PubMed

28.

Xing Z, Gauldie J, Cox G, Baumann H, Jordana M, Lei XF, Achong MK: IL-6 is an antiinflammatory cytokine required for controlling local or systemic acute inflammatory responses. J Clin Invest. 1998, 101: 311-20. 10.1172/JCI1368.PubMedCentralCrossRefPubMed

29.

Koller M, Clasbrummel B, Kollig E, Hahn MP, Muhr G: Major injury induces increased production of interleukin-10 in human granulocyte fractions. Langenbecks Arch Surg. 1998, 383: 460-465. 10.1007/s004230050155.CrossRefPubMed

30.

Partrick DA, Moore FA, Moore EE, Biffl Wl, Sauaia A, Barnett CC: Jack A. Barney resident research award winner. The inflammatory profile of interleukin-6, interlukin-8, and soluble intercellular adhesion molecule-1 in post injury multiple organ failure. Am J Surg. 1996, 172: 425-429. 10.1016/S0002-9610(96)00252-8.CrossRefPubMed

31.

Andersen SK, Toft P, E Tønnesen: Immunological aspects of major trauma with special reference to cytokines. Placebo. 2001, 4: 123-126. [http://www.univ-lille1.fr/lea/Menu_du_Site/Publications/Acrobat/Placebo%202-4.pdf#page=26]

32.

Toft P, Tønnesen E, Helbo-Hansen HS, Lillevang ST, Rasmussen JW, Christensen NJ: Redistribution of granulocytes in patients after major surgical stress. APMIS. 1994, 102: 43-48. 10.1111/j.1699-0463.1994.tb04843.x.CrossRefPubMed

33.

Botha AJ, Moore FA, Moore EE, Sauaia A, Banerjee A, Peterson VW: Early neutrophil sequestration after injury. A pathogenic mechanism for multiple organ failure. J Trauma. 1995, 39: 411-417. 10.1097/00005373-199509000-00003.CrossRefPubMed

34.

Taneja R, Parodo J, Jia SH, Kapus A, Rotstein OD, Marshall JC: Delayed neutrophil apoptosis in sepsis is associated with maintenance of mitochondrial transmembrane potential and reduced caspase-9 activity. Crit Care Med. 2004, 32: 1460-1469. 10.1097/01.CCM.0000129975.26905.77.CrossRefPubMed

35.

Koike K, Moore FA, Moore EE, Poggetti RS, Tuder RM, Banerjee A: Endotoxin after gut ischemia/reperfusion causes irreversible lung injury. J Surg Res. 1992, 52: 556-562. 10.1016/0022-4804(92)90145-P.CrossRef

36.

Toft P, Krog J, Brix-Christensen V, Beck J, Dagnæs-Hansen F, Obel N, Bendix-Hansen K, Jørgensen HS: The effect of CVVHDF and endotoxin on the oxidative burst, adhesion molecules and distribution in tissues of granulocytes. Intensive Care Med. 2000, 26: 770-775. 10.1007/s001340051245.CrossRefPubMed

37.

Nuytinck HK, Offermans XJ, Kubat K, Goris JA: Whole-body inflammation in trauma patients. An autopsy study. Arch Surg. 1988, 123: 1519-1524.CrossRefPubMed

38.

Seekamp A, Jochum M, Ziegler M, van Griensven M, Martin M, Regel G: Cytokines and adhesion molecules in elective and accidental trauma-related ischemia/reperfusion. J Trauma. 1998, 44: 874-882. 10.1097/00005373-199805000-00022.CrossRefPubMed

39.

White-Owen C, Alexander JW, Babcock CF: Reduced expression of neutrophil CD 11b and CD 16 after severe traumatic injury. J Surg Res. 1992, 52: 22-26. 10.1016/0022-4804(92)90273-3.CrossRefPubMed

40.

Ayala A, Ertel W, Chaundry IH: Trauma-induced suppression of antigen presentation and expression of major histocompatibility class II antigen complex in leukocytes. Shock. 1996, 5: 79-90. 10.1097/00024382-199602000-00001.CrossRefPubMed

41.

Giannoudis PV, Smith RM, Perry SL, Windsor AJ, Dickson RA, Bellamy MC: Immediate IL-10 expression following major orthopaedic trauma. Relationship to anti-inflammatory response and subsequent development of sepsis. Intensive Care Med. 2000, 26: 1076-1081. 10.1007/s001340051320.CrossRefPubMed

42.

Polk HC, Cheadle Wg, Livingston DH, Rodriques JL, Starko KM, Izu AE, Jaffe HS, Sonnefeld G: A randomized prospective clinical trial to determine the efficacy of interferon-gamma in severely injured patients. Am J Surg. 1992, 163: 191-196. 10.1016/0002-9610(92)90099-D.CrossRefPubMed

43.

Jira M, Polacek V, Strejcek J, Fara M, Konigova R: Natural killer cell activity following thermal injury. Scand J Plast Reconstr Surg. 1988, 22: 131-133. 10.3109/02844318809072384.CrossRef

44.

Napolitano LM, Campbell C: Polymicrobial sepsis following trauma inhibits interleukin-10 secretion and lymphocyte proliferation. J. Trauma. 1995, 39: 104-111. 10.1097/00005373-199507000-00014.CrossRefPubMed

45.

Decker D, Schorndorf M, Bidlingmaier F, Hirner A, von Ruecker AA: Surgical stress induces a shift in the type 1/type 2- helper cell balance suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to trauma. Surgery. 1996, 119: 316-325. 10.1016/S0039-6060(96)80118-8.CrossRefPubMed

46.

Peltz ED, Moore EE, Eckels PC, Damle SS, Tsuruta Y, Johnson JL, Sauaia A, Silliman CC, Banerjee A, Abraham : HGMB1 is markedly elevated within six hours of mechanical trauma in humans. Shock. 2009, 32: 17-22. 10.1097/SHK.0b013e3181997173.PubMedCentralCrossRefPubMed

47.

Sperry JL, Friese RS, Frankel HL, West MA, Cuschieri J, Moore EE, Harbrecht BG, Peitzman AB, Billiar TR, Maier RV, Remick DG, Minei JP, Inflammation the Host Response to Injury Investigators: Male gender is associated with excessive IL-6 expression following severe injury. J Trauma. 2008, 64: 572-579. 10.1097/TA.0b013e3181650fdf.CrossRefPubMed

48.

Kobbe P, Stoffels B, Schmidt J, Tsukamoto T, Gutkin DM, Bauer AJ, Papa HC: Il-10 defiencency augments acute lung but not liver injury in hemorrhagic shock. Cytokine. 2009, 45: 26-31. 10.1016/j.cyto.2008.10.004.CrossRefPubMed

49.

Yago H, Yoshii H, Naiki M, Suehiro S: Stress and murine NK cell function: the role of blood loss. J Clin Lab Immonol. 1992, 37: 123-132.

50.

Waymack JP, Fernandes G, Yurt RW, Venkatraman JT, Burleson DG, Guzman RF, Mason AD, Pruitt BA: Effect of blood transfusion on immune function. Surgery. 1990, 108: 172-177.PubMed

51.

Flohé S, Kobbe P, Nast-Kolb D: Immunological reactions secondary to blood transfusion. Injury. 2007, 38: 1405-1408. 10.1016/j.injury.2007.09.028.CrossRefPubMed

52.

Izuishi K, Tsung A, Jeyabalan G, Critchlow ND, Li J, Tracey KJ, Demarco RA, Lotze MT, Fink MP, Geller DA, Billiar TR: Cutting edge: high-mobility group box 1 preconditioning protects against liver ischemia-reperfusion injury. J Immunol. 2006, 176: 7154-7158.CrossRefPubMed

53.

Jeyabalan G, Tsung A, Billiar TR: Linking proximal and downstream signalling events in hepatic ischaemia/reperfusion injury. Biochem Soc Trans. 2006, 34 (Pt 5): 957-9.CrossRefPubMed

54.

Arumugam TV, Shiels IA, Woodruff TM, Granger DN, Taylor SM: The role of the complement system in ischemia-reperfusion injury. Shock. 2004, 21: 401-409. 10.1097/00024382-200405000-00002.CrossRefPubMed

55.

Boros P, Bromberg JS: New cellular and molecular immune pathways in ischemia/reperfusion injury. Am J Transplant. 2006, 6: 652-658. 10.1111/j.1600-6143.2005.01228.x.CrossRefPubMed

56.

Stahel PF, Heyde CE, Wyrwich W, Ertel W: Current concepts of polytrauma management: from ATLS to "damage control". Orthopade. 2005, 34: 823-836. 10.1007/s00132-005-0842-5.CrossRefPubMed

57.

Rajagopalan S, Mascha E, Na J, Sessler DI: The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008, 108: 71-7. 10.1097/01.anes.0000296719.73450.52.CrossRefPubMed

58.

Flohé S, Lendemans S, Selbach C, Waydhas C, Ackermann M, Schade FU, Kreuzfelder E: Effect of granulocyte-macrophage colony-stimulating factor on the immune response of circulating monocytes after severe trauma. Crit Care Med. 2003, 31: 2462-2469. 10.1097/01.CCM.0000089640.17523.57.CrossRefPubMed

59.

Gebhard F, Pfetsch H, Steinbach G, Strecker W, Kinzl L, Brückner UB: Is interleukin 6 an early marker of injury severity following major trauma in humans?. Arch Surg. 2000, 135: 291-295. 10.1001/archsurg.135.3.291.CrossRefPubMed

60.

Gebhard F, Huber-Lang M: Polytrauma-pathophysiology and management principles. Langenbecks Arch Surg. 2008, 393: 825-831. 10.1007/s00423-008-0334-2.CrossRefPubMed

61.

Ogura H, Tanaka H, Koh T, Hashiguchi N, Kuwagata Y, Hosotsubo H, Shimazu T, Sugimoto H: Priming, second-hit priming, and apoptosis in leukocytes from trauma patients. J Trauma. 1999, 46: 774-781. 10.1097/00005373-199905000-00004.CrossRefPubMed

62.

Kelbel I, Weiss M: Anaesthetics and immune function. Curr Opin Anaesthesiology. 2001, 14: 685-691. 10.1097/00001503-200112000-00015.CrossRef

63.

Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999, 354: 1851-1858. 10.1016/S0140-6736(98)12251-1.CrossRefPubMed

Title: Pathophysiology of the systemic inflammatory response after major accidental trauma
Authors: Anne Craveiro Brøchner
Palle Toft
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2009
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/1757-7241-17-43

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pathophysiology of the systemic inflammatory response after major accidental trauma

Abstract

Background

Methods

Discussion

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Conclusion

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