The inflammatory response to surgery and trauma.
OBJECTIVE
The inflammatory or stress response to injury has evolved to ensure survival. This review will examine this response in otherwise healthy patients. Additionally, the impact of several common comorbid conditions on the inflammatory response will be considered. What will become evident is that the stress response may be exaggerated in some conditions and suppressed in others. Rapid identification of both an abnormal response and its cause will allow clinicians to maximize a patient's healing potential.


RESULTS
Recent work has shown that an altered inflammatory response has marked effects on both immune competence and the endocrine system. Investigations are ongoing to delineate the mechanism of lymphocyte dysfunction. With regard to critical care endocrinopathies, the effects of insulin and hyperglycemia on inflammation and wound healing are being investigated.


CONCLUSIONS
An understanding of the stress response will aid the clinician in preparing for expected responses, recognizing and perhaps correcting deviations from the norm and accounting for potential complications that arise in the face of preexisting disease. Deviations from the normal time course may represent the effects of preexisting medical illness, treatment or postoperative/injury complications.
Kohl
Benjamin A
BA
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Deutschman
Clifford S
CS
D006801:Humans; D013312:Stress, Physiological / Q000150:complications / Q000503:physiopathology; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology* / Q000503:physiopathology*; D014947:Wounds and Injuries / Q000150:complications*