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Pathophysiologie des Polytraumas

Intensivmedizin und „Timing“ der Versorgung

Pathophysiology of multiple trauma

Intensive care medicine and timing of treatment

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Zusammenfassung

Im Rahmen des schweren Polytraumas („first hit“) reagiert das Immunsystem zweiphasig mit früher Hyperinflammation und nachfolgender Immunsuppression. Eine Vielzahl humoraler und zellulärer Faktoren ist in diesen Prozess involviert. Abhängig von der individuellen Prädisposition, Verletzungsschwere und Verletzungsmuster kann jeweils die eine oder andere überschießende Reaktion zu Sepsis und Multiorganversagen führen. Verschiedene klinische und intensivmedizinische Parameter zeigen eine Stabilisierung der einzelnen Organsysteme an. Der weitere klinische Verlauf kann durch eine adäquate Intensivtherapie mit Vermeidung weitere iatrogener „second hits“ durch verschiebbare Folgeoperationen in der Phase der immunologischen Dekompensation positiv beeinflusst werden. Neben dem zeitlichen Abstand zum Trauma stellen adäquate Oxygenierung, negative Bilanz, Gerinnungsstabilisierung, rückläufige Infektparameter und Normalisierung des Laktats wesentliche Entscheidungsparameter dar.

Abstract

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.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Wutzler, T. Lustenberger, B. Relja, M. Lehnert und I. Marzi geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland

    S. Wutzler, T. Lustenberger, B. Relja, M. Lehnert & I. Marzi

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  1. S. Wutzler
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  2. T. Lustenberger
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  3. B. Relja
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  4. M. Lehnert
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  5. I. Marzi
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Correspondence to S. Wutzler.

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Wutzler, S., Lustenberger, T., Relja, B. et al. Pathophysiologie des Polytraumas. Chirurg 84, 753–758 (2013). https://doi.org/10.1007/s00104-013-2477-0

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