The effect of resuscitation strategy on the longitudinal immuno-inflammatory response to blunt trauma

Bonde, Alexander; Kirial, Rasmus; Svenningsen, Peter; Sillesen, Martin

doi:10.1016/j.injury.2017.09.026

Cited by 2 publications

(2 citation statements)

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“…From the view of temporal linearity, all pharmacological resuscitative efforts root in the hemorrhage of multiple trauma. The significant results in these studies might be the logical temporal consequence of hemorrhage [5,[20][21][22]. It is hard to distinguish between the blood loss and trauma load as the reason for the pro-inflammatory state.…”

Section: Discussionmentioning

confidence: 95%

“…In the current study, the question was addressed whether clinical indicators of initial blood loss due to multiple injuries are associated with proinflammatory changes. Previous publications in this field discussed the trauma load, the amount of transfusions, plasma expanders and other resuscitative efforts as indicators for the development of SIRS in the multiple injured patient [5,[20][21][22]. From the view of temporal linearity, all pharmacological resuscitative efforts root in the hemorrhage of multiple trauma.…”

Section: Discussionmentioning

confidence: 99%

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The initial trauma associated hemorrhagic shock in the multiply injured patient has pro-inflammatory effects. A retrospective single center cohort study

Heining¹,

Keller²,

Simmen³

et al. 2018

Trauma Emerg Care

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Background:The development of a Systemic Inflammatory Response Syndrome (SIRS) has been discussed to be related to the trauma load. Trauma, especially the multiple injured patient suffers blood loss in a various extent. The outcome of such patients is also linked with the need for transfusions and SIRS. Therefore, the association between the initial blood loss and the incidence of IL 6 release following multiple injuries was examined.Methods: Totally 545 patients ≥16 years and with an ISS >16 were included into this retrospective cohort study. The sample was divided according to the ATLS shock classes I-IV on admission in the trauma bay and the shock-index (< 0,5; 0.5-1.5 and > 1.5) at trauma site. The systemic levels of IL6 were measured 24 and 48 hours after admission. Data were analyzed using Kruskal-Wallis H test. The predictive quality was tested using receiver-operating curves (AUC), the independent predictive power was analyzed using binary logistic regression. The analysis was conducted using IBM SPSS ® 23.0. Level of evidence III.Results: IL6 significantly increased within the first 24h according to shock (252ng -872ng, p < 0.001). There were highly predictive values between IL6 and SIRS (24h) (AUC: 0.345 -0.951 for ATLS shock I-IV, p < 0.001; AUC: 0.443 -0.963 for shock-index 0.5 -1.5, p < 0.001). ATLS shock revealed as an independent predictor for IL6 increase after 48h (p < 0.001). Conclusion:Initial shock-index at trauma site and the ATLS shock degree in the trauma bay are high predictors for IL6 release what may serve as a primer for the induction of SIRS. Very early control of blood loss seems to be the key point. However, these results might also point on the change of transfusion protocols in the multiple injured patient.

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Section: Discussionmentioning

confidence: 95%