[Pathophysiology of multiple trauma : intensive care medicine and timing of treatment].
After severe multiple injuries (first hit) a two-phase immunological response with early hyperinflammation followed by immunosuppression can be observed. This process involves a variety of humoral and cellular factors. Depending on the individual predisposition, overall injury severity and injury pattern, both reactions can lead to sepsis and multiorgan failure. Various clinical and intensive care parameters indicate stabilization of specific organ functions. The clinical course can be positively influenced by adequate intensive care therapy, avoiding iatrogenic second hits by non-emergency surgical interventions during a phase of immunological dysregulation. Important decision parameters besides time to initial trauma include adequate oxygenation, no coagulopathy, declining inflammatory mediators and normalized serum lactate.
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland, sebastian.wutzler@kgu.de.
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Wutzler
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Lustenberger
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Relja
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Lehnert
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Marzi
D001777:Blood Coagulation / Q000502:physiology; D002423:Cause of Death; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D003422:Critical Care / Q000379:methods*; D003663:Decision Trees; D017052:Hospital Mortality; D006801:Humans; D007108:Immune Tolerance / Q000502:physiology; D018836:Inflammation Mediators / Q000097:blood; D033183:Interdisciplinary Communication; D019344:Lactic Acid / Q000097:blood; D009102:Multiple Organ Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D009104:Multiple Trauma / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D010100:Oxygen / Q000097:blood; D011379:Prognosis; D012086:Reoperation; D018746:Systemic Inflammatory Response Syndrome / Q000401:mortality / Q000503:physiopathology / Q000601:surgery
D018836:Inflammation Mediators; D019344:Lactic Acid; D010100:Oxygen