The intersection of coagulation activation and inflammation after injury: What you need to know

Abstract

The systemic inflammatory response syndrome (SIRS) after severe injury can lead to distant organ injury, multi-organ failure, and complications during recovery. Post-injury SIRS is driven by the activation of innate immune cells and release of pro-inflammatory cytokines that drives this inflammation response. In addition, the coagulation cascade and complement system is altered, resulting in a widespread inflammatory response. Importantly, these different components of SIRS are interrelated and propagate further alterations in thrombosis and inflammation. Efforts to mitigate the acute changes in coagulation and inflammation and its complex interactions following injury could provide novel strategies for resuscitation and management of complications of trauma-induced coagulopathy, SIRS, and multiple organ failure. In this review, we review the pathophysiology of post-traumatic SIRS and highlight current approaches to mitigate innate immune cell activation, thromboinflammation, and associated clinical complications. Level of Evidence IV, Review article

What do we mean by source control and what are we trying to accomplish with an open abdomen in severe complicated intra-abdominal sepsis?

“…Pharmacologic approaches do not currently offer hope in severe complicated intra-abdominal sepsis, as studies of promising agents targeting postinfective inflammation have not improved patient outcomes 7–9 . Thus, surgical investigators need to keep exploring basic science and exploring new approaches that might include the intersection of coagulation, inflammation, and inflammation 10 or novel methods to remove biomediators as early as possible after generation such as with hemofiltration 11 or potentially negative pressure peritoneal therapy 12 …”