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Systemic Response to Injury

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Textbook of Emergency General Surgery

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Abstract

Regardless of the mechanism, severe traumatic injury initiates local and systemic inflammatory responses. The crux of the inflammatory response without pathogens is the detection of the damaged or dying “self”, which initiates a prompt response from the innate immune system. When overactivated and uncontrolled, systemic inflammatory response syndrome (SIRS) via innate cellular and humoral mechanisms can damage organs not involved in the primary injury and also compromise adaptive immune response and the process of regeneration. This in turn can lead to infectious complications, organ failure, and death. Accumulating evidence in recent years has demonstrated the important role of damage-associated molecular patterns (DAMPs) in the pathogenesis of the innate immune response to traumatic insults with potential new therapeutic interventions for attenuating the inflammatory response rather than the previously largely unsuccessful downstream cellular and molecular targets. Resuscitative measures in the trauma patient must serve to counteract SIRS, rather than exacerbating it with further tissue and physiological injury. End-organ hypoxia and hypoperfusion should be minimized, bleeding should be controlled as early as possible, volume replacement with crystalloid fluid should be minimized in favour of blood products, and timing and magnitude of surgery (as additional tissue injury) are paramount.

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Authors and Affiliations

  1. Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia

    Philip F. Dobson, Karen Muller & Zsolt J. Balogh

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Correspondence to Zsolt J. Balogh .

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  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Dobson, P.F., Muller, K., Balogh, Z.J. (2023). Systemic Response to Injury. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_8

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  • DOI: https://doi.org/10.1007/978-3-031-22599-4_8

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-031-22599-4

  • eBook Packages: MedicineMedicine (R0)

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