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Intensive Care Medicine

, Volume 30, Issue 1, pp 96–102 | Cite as

Influence of surgical intervention in the immune response of severely injured patients

  • Sascha FlohéEmail author
  • Sven Lendemans
  • Fritz-Ulrich Schade
  • Ernst Kreuzfelder
  • Christian Waydhas
Original

Abstract

Objective

Primary events such as severe injury and elective surgery cause a deterioration of the immune response measurable by reduction of expression of HLA-DR on monocytes or ex vivo LPS-induced TNFα production. The further influence of secondary surgery after severe injury on the immune response remains unresolved.

Design

Prospective observation study.

Setting

Surgical intensive care unit of an university hospital.

Patients

Sixteen severely injured patients with an ISS >25 points.

Measurements and results

On day 1 after trauma and immediately before secondary surgery, mean fluorescence intensity (MFI) of HLA-DR expression on monocytes and TNFα ex vivo synthesis was significantly reduced compared to healthy donors. Overall, surgical intervention during the second week after trauma caused no further reduction of HLA-DR expression on monocytes and of the ex vivo TNFα-synthesis. However, major surgery such as intramedullary nailing or pelvic osteosynthesis caused reduction of the HLA-DR expression and TNFα-synthesis, whereas, minor surgical interventions such as osteosynthesis on peripheral joints exhibited no significant effects on the immune response. Surgical intervention performed to clear septic foci normalised immune response by elevating HLA-DR expression on monocytes and ex vivo TNFα synthesis. Severe injury caused elevated serum IL-10 levels, whereas secondary surgery did not induce a further increase in serum IL-10 levels.

Conclusion

This study shows that initial trauma as well as major secondary surgery causes a suppression of immune functions, whereas minor secondary surgery does not cause significant immune disturbance.

Keywords

Trauma HLA-DR Surgery Immune response TNFα 

Notes

Acknowledgement

The IFORES program of the university of Essen financially supported this work.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Sascha Flohé
    • 1
    Email author
  • Sven Lendemans
    • 1
  • Fritz-Ulrich Schade
    • 1
  • Ernst Kreuzfelder
    • 2
  • Christian Waydhas
    • 1
  1. 1.Department of Trauma SurgeryUniversity Hospital of EssenEssenGermany
  2. 2.Institute of ImmunologyUniversity Hospital of EssenEssenGermany

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