Systemic inflammatory response syndrome (SIRS) in serious chest injuries: is a pharmacological blockade effective?
OBJECTIVE
There has been an ongoing increase in the frequency and severity of blunt chest injuries. Their rather high lethality is caused by the injury alone as well as by the following systemic inflammatory response. The aim of the study is to verify the efficacy of the pharmacological blockade of the systemic inflammatory response syndrome (SIRS) in serious blunt chest injuries, and to identify whether the administration of indomethacin as a cyclooxygenase inhibitor could prevent a multiorgan dysfunction (MODS) and a multiorgan failure (MOF).


METHODS
Patients were divided into 4 Groups according to trauma severity--injury severity score (ISS) and into two subgroups--an indomethacin subgroup where patients received indomethacin together with standard therapy, and a non-indomethacin subgroup.


RESULTS
Eighty-four patients were included in the study and 33 patients were given indomethacin. In Groups III and IV there was a later increase in inflammatory markers in patients treated with indomethacin. The elevation of inflammatory markers and the period of mechanical ventilation support in patients treated with indomethacin were shorter in Groups II and III. Seven (8.3%) patients died. Six of the seven dead patients were from the non-indomethacin subgroup. MOF was the cause of death in two patients in the non-indomethacin subgroup and in one patient in the indomethacin subgroup.


CONCLUSIONS
The results obtained during the first 20 months of the study imply that a certain number of patients with serious blunt chest trauma could benefit from indomethacin administration.
Havlícek
Karel
K
The Institute of Medical Studies, The University of Pardubice, and Department of Surgery, Pardubice General Hospital, Pardubice, Czech Republic.
Motycka
Vladimír
V
Siller
Jirí
J
Cervinka
Vladimír
V
D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007213:Indomethacin / Q000008:administration & dosage*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality
D007213:Indomethacin