Skip to main content
SpringerLink
Log in

Der Faktor „Zeit“

Seine Bedeutung in der Pathophysiologie und Therapie des Polytraumas

The factor “Time”

Its impact in pathophysiology and therapy of multiple trauma

  • Leitthema
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Die Pathophysiologie des Polytraumas ist von den unterschiedlichen Primärauswirkungen des Traumas wie z. B. dem Verlust von Blut, der Zerstörung parenchymatöser Organe, dem Kontakt immunaktiver Zellen mit Fremdprotein und der konsekutiven systemischen Entzündungsreaktion beeinflusst. Dabei hat die Einwirkdauer des schädlichen Agens einen substanziellen Einfluss auf die Ausprägung des posttraumatischen Schadens. Ziel der vorliegenden Übersicht ist es, den Einfluss der Zeit auf die primär auslösenden pathophysiologischen Mechanismen näher aufzuzeigen und die Bedeutung einer möglichst raschen therapeutischen Intervention im Zusammenhang mit dem jeweiligen singulären Schädigungsmechanismus zu verdeutlichen.

Abstract

Pathophysiology of multiple trauma is characterized by different trauma-associated repercussions like organ destruction, haemorrhage, immune cell activation by foreign antigen, for example. The length of time while such impairments take hold of the organism substantially impacts the extent of the post trauma secondary injury. Short interruptions in microcirculation can mostly be compensated, whereas elongated ischemic periods definitely cause structural cell damage up to death. The current review highlights the importance of the time duration of posttrauma second hits on the pathophysiology of systemic inflammation and multiple organ failure. The quick termination of such secondary impairments by immediate therapeutic intervention mainly impacts the patients’ prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Sauaia A, Moore FA, Moore EE et al (1995) Epidemiology of trauma deaths: a reassessment. J Trauma 38(2):185–193

    Article  PubMed  CAS  Google Scholar 

  2. Mannick JA, Rodrick ML, Lederer JA (2001) The immunologic response to injury. J Am Coll Surg 193(3):237–244

    Article  PubMed  CAS  Google Scholar 

  3. Keel M, Trentz O (2005) Pathophysiology of polytrauma. Injury 36(6):691–709

    Article  PubMed  Google Scholar 

  4. Waydhas C, Nast-Kolb D, Trupka A et al (1996) Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. J Trauma 40(4):624–630

    Article  PubMed  CAS  Google Scholar 

  5. Tschoeke SK, Hellmuth M, Hostmann A et al (2007) The early second hit in trauma management augments the proinflammatory immune response to multiple injuries. J Trauma 62(6):1396–1403

    Article  PubMed  Google Scholar 

  6. Biberthaler P, Bogner V, Baker HV et al (2005) Genome-wide monocytic mRNA expression in polytrauma patients for identification of clinical outcome. Shock 24(1):11–19

    Article  PubMed  CAS  Google Scholar 

  7. Bogner V, Kirchhoff C, Baker HV et al (2007) Gene expression profiles are influenced by ISS, MOF, and clinical outcome in multiple injured patients: a genome-wide comparative analysis. Langenbecks Arch Surg 392(3):255–265

    Article  PubMed  CAS  Google Scholar 

  8. Shoemaker WC, Peitzman AB, Bellamy R et al (1996) Resuscitation from severe hemorrhage. Crit Care Med 24 [suppl 2]:S12–S23

    Google Scholar 

  9. Peitzman AB, Billiar TR, Harbrecht BG et al (1995) Hemorrhagic shock. Curr Probl Surg 32(11):925–1002

    Article  PubMed  CAS  Google Scholar 

  10. Singer M, De SV, Vitale D, Jeffcoate W (2004) Multiorgan failure is an adaptive, endocrine-mediated, metabolic response to overwhelming systemic inflammation. Lancet 364(9433):545–548

    Article  PubMed  Google Scholar 

  11. Menger MD, Vollmar B (2007) Pathomechanisms of ischemia-reperfusion injury as the basis for novel preventive strategies: is it time for the introduction of pleiotropic compounds? Transplant Proc 39(2):485–488

    Article  PubMed  CAS  Google Scholar 

  12. Mikhalski D, Wissing KM, Ghisdal L et al (2008) Cold ischemia is a major determinant of acute rejection and renal graft survival in the modern era of immunosuppression. Transplantation 85 [suppl 7]:S3–S9

    Google Scholar 

  13. Pillay J, Hietbrink F, Koenderman L, Leenen LP (2007) The systemic inflammatory response induced by trauma is reflected by multiple phenotypes of blood neutrophils. Injury 38(12):1365–1372

    Article  PubMed  CAS  Google Scholar 

  14. Zallen G, Moore EE, Johnson JL et al (1999) Circulating postinjury neutrophils are primed for the release of proinflammatory cytokines. J Trauma 46(1):42–48

    Article  PubMed  CAS  Google Scholar 

  15. Giannoudis PV (2003) Current concepts of the inflammatory response after major trauma: an update. Injury 34(6):397–404

    PubMed  CAS  Google Scholar 

  16. Bhatia M, Moochhala S (2004) Role of inflammatory mediators in the pathophysiology of acute respiratory distress syndrome. J Pathol 202(2):145–156

    Article  PubMed  CAS  Google Scholar 

  17. Martinez-Mier G, Toledo-Pereyra LH, Ward PA (2001) Adhesion molecules and hemorrhagic shock. J Trauma 51(2):408–415

    Article  PubMed  CAS  Google Scholar 

  18. Deitch EA, Rutan R, Waymack JP (1996) Trauma, shock, and gut translocation. New Horiz 4(2):289–299

    PubMed  CAS  Google Scholar 

  19. Kreimeier U, Lackner CK, Pruckner S et al (2002) Permissive hypotension in severe trauma. Anaesthesist 51(10):787–799

    Article  PubMed  CAS  Google Scholar 

  20. Moore FA, McKinley BA, Moore EE (2004) The next generation in shock resuscitation. Lancet 363(9425):1988–1996

    Article  PubMed  Google Scholar 

  21. Bogner V, Kirchhoff C, Baker HV et al (2007) Gene expression profiles are influenced by ISS, MOF, and clinical outcome in multiple injured patients: a genome-wide comparative analysis. Langenbecks Arch Surg 392(3):255–265

    Article  PubMed  CAS  Google Scholar 

  22. Moore EE, Johnson JL, Cheng AM et al (2005) Insights from studies of blood substitutes in trauma. Shock 24(3):197–205

    Article  PubMed  CAS  Google Scholar 

  23. Moore FA, Moore EE, Sauaia A (1997) Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg 132(6):620–624

    PubMed  CAS  Google Scholar 

  24. Dunne JR, Malone DL, Tracy JK, Napolitano LM (2004) Allogenic blood transfusion in the first 24 hours after trauma is associated with increased systemic inflammatory response syndrome (SIRS) and death. Surg Infect (Larchmt) 5(4):395–404

    Google Scholar 

  25. Malone DL, Dunne J, Tracy JK et al (2003) Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 54(5):898–905

    Article  PubMed  Google Scholar 

  26. Johnson JL, Moore EE, Gonzalez RJ et al (2003) Alteration of the postinjury hyperinflammatory response by means of resuscitation with a red cell substitute. J Trauma 54(1):133–139

    Article  PubMed  Google Scholar 

  27. Von Dobschuetz E, Hoffmann T, Messmer K (1999) Diaspirin cross-linked hemoglobin effectively restores pancreatic microcirculatory failure in hemorrhagic shock. Anesthesiology 91(6):1754–1762

    Article  Google Scholar 

  28. Rushing GD, Britt LD (2008) Reperfusion injury after hemorrhage: a collective review. Ann Surg 247(6):929–937

    Article  PubMed  CAS  Google Scholar 

  29. Stahel PF, Heyde CE, Wyrwich W, Ertel W (2005) Current concepts of polytrauma management: from ATLS to „damage control“. Orthopäde 34(9):823–836

    Article  PubMed  CAS  Google Scholar 

  30. Spahn DR, Cerny V, Coats TJ et al (2007) Management of bleeding following major trauma: a European guideline. Crit Care 11(1):R17

    Article  PubMed  Google Scholar 

  31. Karakurum M, Shreeniwas R, Chen J et al (1994) Hypoxic induction of interleukin-8 gene expression in human endothelial cells. J Clin Invest 93(4):1564–1570

    Article  PubMed  CAS  Google Scholar 

  32. Murdoch C, Muthana M, Lewis CE (2005) Hypoxia regulates macrophage functions in inflammation. J Immunol 175(10):6257–6263

    PubMed  CAS  Google Scholar 

  33. Lim HB, Smith M (2007) Systemic complications after head injury: a clinical review. Anaesthesia 62(5):474–482

    Article  PubMed  CAS  Google Scholar 

  34. Collins TJ, Samworth PJ (2008) Therapeutic hypothermia following cardiac arrest: a review of the evidence. Nurs Crit Care 13(3):144–151

    Article  PubMed  Google Scholar 

  35. Sahuquillo J, Vilalta A (2007) Cooling the injured brain: how does moderate hypothermia influence the pathophysiology of traumatic brain injury. Curr Pharm Des 13(22):2310–2322

    Article  PubMed  CAS  Google Scholar 

  36. Malone DL, Kuhls D, Napolitano LM et al (2001) Back to basics: validation of the admission systemic inflammatory response syndrome score in predicting outcome in trauma. J Trauma 51(3):458–463

    Article  PubMed  CAS  Google Scholar 

  37. Seekamp A, van Griensven M, Hildebrandt F et al (1999) Adenosine-triphosphate in trauma-related and elective hypothermia. J Trauma 47(4):673–683

    Article  PubMed  CAS  Google Scholar 

  38. Cuthbertson DP (1980) Alterations in metabolism following injury: part I. Injury 11(3):175–189

    Article  PubMed  CAS  Google Scholar 

  39. Heindl B, Biberthaler P (2008) Coagulation management of severe surgical bleeding. Unfallchirurg 111(8):574–583

    Article  PubMed  CAS  Google Scholar 

  40. Esmon CT (2005) The interactions between inflammation and coagulation. Br J Haematol 131(4):417–430

    Article  PubMed  CAS  Google Scholar 

  41. Probst C, Pape HC, Hildebrand F et al (2009) 30 years of polytrauma care: An analysis of the change in strategies and results of 4849 cases treated at a single institution. Injury 40(1):77–83

    Article  PubMed  Google Scholar 

  42. American College of Surgeons (1993) Advanced Trauma Life Support for physicians: Instructor Manual, pp 75–110

Download references

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Innenstadt, Nussbaumstr. 20, 80336, München, Deutschland

    V. Bogner, W. Mutschler & P. Biberthaler

Authors
  1. V. Bogner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Mutschler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Biberthaler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Bogner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bogner, V., Mutschler, W. & Biberthaler, P. Der Faktor „Zeit“. Unfallchirurg 112, 838–845 (2009). https://doi.org/10.1007/s00113-009-1606-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-009-1606-1

Schlüsselwörter

Keywords

Search

Navigation