PMID: 9532419Apr 9, 1998Paper

The cellular, immune, and metabolic response to trauma

Critical Reviews in Clinical Laboratory Sciences
P Gosling

Abstract

The major challenge in treatment of the multiple trauma victim has shifted from early and effective resuscitation to treatment of the host response to injury. Patients surviving for the first 24 h after major injury as a result of effective resuscitation remain at risk of progressive organ failure and death from what appears to be an uncontrolled inflammatory process. A septic cause is frequently not identifiable, yet the response is as if the patient were infected. While organ-supportive measures such as mechanical ventilation, extracorporeal membrane oxygenation, renal replacement therapies, and total parenteral nutrition help to maintain tissue substrate delivery and metabolite removal, these therapies eventually fail if the microvaculature ceases to function. As the soluble and cell-mediated pathways of the inflammatory response are now being unraveled, possible interventions designed to attenuate selected elements of the inflammatory pathways are being developed. These measures include antioxidants, enzyme inhibitors, pharmacological agents, antibodies both to soluble mediators and cell surface receptor antagonists. Most of these interventions are at the experimental stage and so far have only met with limited clinical suc...Continue Reading

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