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Multiorgan Dysfunction in Trauma and Surgical Intensive Care Units

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Technological Advances in Surgery, Trauma and Critical Care

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Abstract

Multiple organ dysfunction syndrome (MODS) is a systemic, dysfunctional inflammatory response which is a leading cause of high cost hospital admissions and increased mortality (27–100 %). Due to a number of developments, such as our better understanding of the MODS, technological advances in the diagnosis (use of a number of biomarkers) and treatment, as well as multidisciplinary approach to patients with Multiple Organ Failure (MOF), this mortality has decreased significantly. A deregulated immunological response is the crucial factor for the pathophysiology of post-injury MODS, which occurs if this inflammatory response is exaggerated or persistent. Lung dysfunction is the main contributor of early MODS followed by cardiac, hepatic, and renal dysfunction.

To date, therapeutic strategies to combat the MODS in trauma patients have focused on control of the post-injury inflammatory response. However, despite great advances that we have seen in MODS, there is a need for the development of newer therapeutic strategies for early detection of MODS and risk-stratification of trauma and surgical ICU patients using biomarker based prospective studies. Particularly, research focusing the implications of novel immunomodulation strategies based on steroid therapy might be useful for minimizing the risk of MODS in multiple trauma patients.

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References

  1. Dewar D, Moore FA, Moore EE, Balogh Z. Postinjury multiple organ failure. Injury. 2009;40:912–8.

    Article  PubMed  Google Scholar 

  2. Maier B, Lefering R, Lehnert M, Laurer HL, Steudel WI, Neugebauer EA, Marzi I. Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock. 2007;28:668–74.

    CAS  PubMed  Google Scholar 

  3. Dewar D, Butcher N, King K, Balogh Z. Post injury multiple organ failure. Trauma. 2011;13:81–91.

    Article  Google Scholar 

  4. Ciesla DJ, Moore EE, Johnson JL, Sauaia A, Cothren CC, Moore JB, Burch JM. Multiple organ dysfunction during resuscitation is not postinjury multiple organ failure. Arch Surg. 2004;139:590–4.

    Article  PubMed  Google Scholar 

  5. Ciesla DJ, Moore EE, Johnson JL, Burch JM, Cothren CC, Sauaia A. The role of the lung in postinjury multiple organ failure. Surgery. 2005;138:749–57.

    Article  PubMed  Google Scholar 

  6. Moore FA, Sauaia A, Moore EE, Haenel JB, Burch JM, Lezotte DC. Postinjury multiple organ failure: a bimodal phenomenon. J Trauma. 1996;40:501–2.

    Article  CAS  PubMed  Google Scholar 

  7. Ciesla DJ, Moore EE, Johnson JL, Burch JM, Cothren CC, Sauaia A. A 12-year prospective study of postinjury multiple organ failure: has anything changed? Arch Surg. 2005;140:432–8.

    Article  PubMed  Google Scholar 

  8. Dewar DC, Tarrant SM, King KL, Balogh ZJ. Changes in the epidemiology and prediction of multiple-organ failure after injury. J Trauma Acute Care Surg. 2013;74(3):774–9.

    Article  PubMed  Google Scholar 

  9. van Wessem KJP, Leenen LPH. The effect of evolving trauma care on the development of multiple organ dysfunction syndrome. Eur J Trauma Emerg Surg. 2014;40:127–34.

    Article  Google Scholar 

  10. Minei JP, Cuschieri J, Sperry J, Moore EE, West MA, Harbrecht BG, O’Keefe GE, Cohen MJ, Moldawer LL, Tompkins RG, et al. The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock. Crit Care Med. 2012;40:1129–35.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Aldrian S, Koenig F, Weninger P, Vecsei V, Nau T. Characteristics of polytrauma patients between 1992 and 2002: what is changing? Injury. 2007;38:1059–64.

    Article  CAS  PubMed  Google Scholar 

  12. Kahl JE, Calvo RY, Sise MJ, Sise CB, Thorndike JF, Shackford SR. The changing nature of death on the trauma service. J Trauma Acute Care Surg. 2013;75:195–201.

    Article  PubMed  Google Scholar 

  13. Nast-Kolb D, Aufmkolk M, Rucholtz S, Obertacke U, Waydhas C. Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma. J Trauma. 2001;51:835–41.

    Article  CAS  PubMed  Google Scholar 

  14. Fröhlich M, Lefering R, Probst C, Paffrath T, Schneider MM, Maegele M, Sakka SG, Bouillon B, Wafaisade A, Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society Sektion NIS. Epidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31,154 patients from the TraumaRegister DGU. J Trauma Acute Care Surg. 2014;76:921–7.

    Article  PubMed  Google Scholar 

  15. Sauaia A, Moore EE, Johnson JL, Chin TL, Banerjee A, Sperry JL, Maier RV, Burlew CC. Temporal trends of postinjury multiple-organ failure: still resource intensive, morbid, and lethal. J Trauma Acute Care Surg. 2014;76:582–92.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Sauaia A, Moore FA, Moore EE, et al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38:185–93.

    Article  CAS  PubMed  Google Scholar 

  17. Moore EE, Moore FA, Harken AH, et al. The two-event construct of post-injury multiple organ failure. Shock. 2005;24 Suppl 1:71–4.

    Article  PubMed  Google Scholar 

  18. Sauaia A, Moore FA, Moore EE, Norris JM, Lezotte DC, Hamman RF. Multiple organ failure can be predicted as early as 12 h after injury. J Trauma. 1998;45:291–301.

    Article  CAS  PubMed  Google Scholar 

  19. Antonelli M, Caricato A. Post-injury multiple organ failure and late outcome. Is it just an association? Crit Care. 2007;11:166.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Peitzman AB, Udekwu AO, Ochoa J, et al. Bacterial translocation in trauma patients. J Trauma. 1991;31:629–38.

    Article  Google Scholar 

  21. Sprung CL. Definitions of sepsis: have we reached a consensus? Crit Care Med. 1991;19:849–51.

    Article  CAS  PubMed  Google Scholar 

  22. Rotstein OD. Modeling the two-hit hypothesis for evaluating strategies to prevent organ injury after shock/resuscitation. J Trauma. 2003;54 Suppl 5:203–6.

    Google Scholar 

  23. Keel M, Trentz O. Pathophysiology of polytrauma. Injury. 2005;36:691–709.

    Article  PubMed  Google Scholar 

  24. Moore FA, Moore EE. Evolving concepts in the pathogenesis of post injury multiple organ failure. Surg Clin North Am. 1995;75:257–77.

    CAS  PubMed  Google Scholar 

  25. El-Menyar A, Al-Thani H, Zakaria E, Zarour A, Tuma M, AbdulRahman H, Parchani A, Peralta R, Latifi R. Multiple organ dysfunction syndrome (mods): is it preventable or inevitable? Int J Clin Med. 2012;3:722–30.

    Article  Google Scholar 

  26. Zakaria ER, Garrison RN, Spain DA, Matheson PJ, Harris PD, Richardson DJ. Intraperitoneal resuscitation improves intestinal blood flow following hemorrhagic shock. Ann Surg. 2003;237:704–13.

    PubMed Central  Google Scholar 

  27. el Zakaria R, Campbell JE, Peyton JC, Garrison RN. Postresuscitation tissue neutrophil infiltration is time-dependent and organ-specific. J Surg Res. 2007;143:119–25.

    Article  PubMed Central  Google Scholar 

  28. el Zakaria R, Li N, Matheson PJ, Garrison RN. Cellular edema regulates tissue capillary perfusion after hemorrhage resuscitation. Surgery. 2007;142:487–96.

    Article  PubMed Central  Google Scholar 

  29. Tsukamoto T, Chanthaphavong RS, Pape HC. Current theories on the pathophysiology of multiple organ failure after trauma. Injury. 2010;41:21–6.

    Article  PubMed  Google Scholar 

  30. Botha AJ, Moore FA, Moore EE, et al. Early neutrophil sequestration after injury: a pathogenic mechanism for multiple organ failure. J Trauma. 1995;39:411–7.

    Article  CAS  PubMed  Google Scholar 

  31. Balk RA. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit Care Clin. 2000;16(2):337–52.

    Article  CAS  PubMed  Google Scholar 

  32. Dunham CM, Damiano AM, Wiles CE, Cushing BM. Post-traumatic multiple organ dysfunction syndrome-infection is an uncommon antecedent risk factor. Injury. 1995;26:373–8.

    Article  CAS  PubMed  Google Scholar 

  33. Pittet D, Rangel-Frausto S, Li N, Tarara D, Costigan M, Rempe L, Jebson P, Wenzel RP. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med. 1995;21:302–9.

    Article  CAS  PubMed  Google Scholar 

  34. Gando S, Nanzaki S, Kemmotsu O. Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma: application of clinical decision analysis. Ann Surg. 1999;229:121–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Baue AE, Faist E, Fry DE, editors. Multiple organ failure: pathophysiology, prevention, and therapy. New York: Springer Science; 2000.

    Google Scholar 

  36. Moore FA, Moore EE, Sauaia A. Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg. 1997;132:620–4.

    Article  CAS  PubMed  Google Scholar 

  37. Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma. 2003;54:898–905.

    Article  PubMed  Google Scholar 

  38. Shorr AF, Duh MS, Kelly KM, Kollef MH, CRIT Study Group. Red blood cell transfusion and ventilator-associated pneumonia: a potential link? Crit Care Med. 2004;32:666–74.

    Article  PubMed  Google Scholar 

  39. Johnson JL, Moore EE, Kashuk JL, Banerjee A, Cothren CC, Biffl WL, Sauaia A. Effect of blood products transfusion on the development of post injury multiple organ failure. Arch Surg. 2010;145:973–7.

    Article  PubMed  Google Scholar 

  40. Roumen RM, Hendriks T, van der Ven-Jongekrijg J, Nieuwenhuijzen GA, Sauerwein RW, van der Meer JW, Goris RJ. Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure. Ann Surg. 1993;218:769–76.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Ni Choileain N, Redmond HP. Cell response to surgery. Arch Surg. 2006;141:1132–40.

    Article  PubMed  Google Scholar 

  42. Waydhas C, Nast-Kolb D, Trupka A, Zettl R, Kick M, Wiesholler J, Schweiberer L, Jochum M. Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. J Trauma. 1996;40:624–30.

    Article  CAS  PubMed  Google Scholar 

  43. Pape H, Stalp M, v Griensven M, Weinberg A, Dahlweit M, Tscherne H. Optimal timing for secondary surgery in polytrauma patients: an evaluation of 4,314 serious-injury cases. Chirurg. 1999;70:1287–93.

    Article  CAS  PubMed  Google Scholar 

  44. Pape HC. Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma. 2001;50:989–1000.

    Article  CAS  PubMed  Google Scholar 

  45. Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA, Lezotte DC. Early predictors of postinjury multiple organ failure. Arch Surg. 1994;129:39–45.

    Article  CAS  PubMed  Google Scholar 

  46. Tran DD, Cuesta MA, van Leeuwen PA, Nauta JJ, Wesdorp RI. Risk factors for multiple organ system failure and death in critically injured patients. Surgery. 1993;114:21–30.

    CAS  PubMed  Google Scholar 

  47. Grossman MD, Ofurum U, Stehly CD, Stoltzfus J. Long-term survival after major trauma in geriatric trauma patients: the glass is half full. J Trauma Acute Care Surg. 2012;72:1181–5.

    PubMed  Google Scholar 

  48. Morris Jr JA, MacKenzie EJ, Edelstein SL. The effect of preexisting conditions on mortality in trauma patients. JAMA. 1990;263:1942–6.

    Article  PubMed  Google Scholar 

  49. Lobo SM, Rezende E, Knibel MF, Silva NB, Páramo JA, Nácul FE, Mendes CL, Assunção M, Costa RC, Grion CC, Pinto SF, Mello PM, Maia MO, Duarte PA, Gutierrez F, Silva Jr JM, Lopes MR, Cordeiro JA, Mellot C. Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients. Anesth Analg. 2011;112:877–83.

    Article  PubMed  Google Scholar 

  50. Durham RM, Moran JJ, Mazuski JE, Shapiro MJ, Baue AE, Flint LM. Multiple organ failure in trauma patients. J Trauma. 2003;55:608–16.

    Article  PubMed  Google Scholar 

  51. Bone R, Balk R, Cerra F, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis:the ACCP/SCCM Consensus Conference Committee—American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–55.

    Article  CAS  PubMed  Google Scholar 

  52. Gu W, Jiang J. Genetic polymorphisms and posttraumatic complications. Comp Funct Genomics. 2010;2010:814086. Article ID 814086, 7 pages.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Jiang JX. Genomic polymorphisms and sepsis. Chin J Traumatol. 2005;21:45–9.

    CAS  Google Scholar 

  54. Deitch EA, Goodman ER. Prevention of multiple organ failure. Surg Clin North Am. 1999;79:1471–88.

    Article  CAS  PubMed  Google Scholar 

  55. Casey LC. Immunologic response to infection and its role in septic shock. Crit Care Clin. 2000;16:193–213.

    Article  CAS  PubMed  Google Scholar 

  56. de Bel EE, Goris RJA. Systemic inflammation after trauma, infection, and cardiopulmonary bypass: is autodestruction a necessary evil? In: Bruce AE, Faist E, Fry DE, editors. Multiorgan failure: pathogenesis, prevention and therapy. New York: Springer-Verlag; 2000. p. 71–81.

    Chapter  Google Scholar 

  57. Read RC, Teare DM, Pridmore AC, et al. The tumor necrosis factor polymorphism TNF (-308) is associated with susceptibility to meningococcal sepsis, but not with lethality. Crit Care Med. 2009;37:1237–43.

    Article  CAS  PubMed  Google Scholar 

  58. Barber RC, Aragaki CC, Rivera-Chavez FA, Purdue GF, Hunt JL, Horton JW. TLR4 and TNF-α polymorphisms are associated with an increased risk for severe sepsis following burn injury. J Med Genet. 2004;41:808–13.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Gu W, Zeng L, Zhou J, et al. Clinical relevance of 13 cytokine gene polymorphisms in Chinese major trauma patients. Intensive Care Med. 2010;36:1261–5.

    Article  CAS  PubMed  Google Scholar 

  60. Pettila V, Pettila M, Sarna S, Voutilainen P, Takkunen O. Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill. Crit Care Med. 2002;30:1705–11.

    Article  PubMed  Google Scholar 

  61. Takeda K, Akira S. Regulation of innate immune responses by toll-like receptors. Jpn J Infect Dis. 2001;54:209–19.

    CAS  PubMed  Google Scholar 

  62. Chen KH, Zeng L, Gu W, Zhou J, Du DY, Jiang JX. Polymorphisms in the toll-like receptor gene associated with sepsis and multiple organ dysfunction after major blunt trauma. Br J Surg. 2011;98:1252–9.

    Article  CAS  PubMed  Google Scholar 

  63. Dewar DC, Mackay P, Balogh Z. Epidemiology of post-injury multiple organ failure in an Australian trauma system. ANZ J Surg. 2009;79:431–6.

    Article  PubMed  Google Scholar 

  64. Bronkhorst MW, Boyé ND, Lomax MA, et al. Single-nucleotide polymorphisms in the toll-like receptor pathway increase susceptibility to infections in severely injured trauma patients. J Trauma Acute Care Surg. 2013;74:862–70.

    Article  CAS  PubMed  Google Scholar 

  65. O’Keefe GE, Hybki DL, Munford RS. The G→A single nucleotide polymorphism at the -308 position in the tumor necrosis factor-alpha promoter increases the risk for severe sepsis after trauma. J Trauma. 2002;52:817–25.

    Article  PubMed  Google Scholar 

  66. Menges T, König IR, Hossain H, et al. Sepsis syndrome and death in trauma patients are associated with variation in the gene encoding tumor necrosis factor. Crit Care Med. 2008;36:1456–62.

    Article  PubMed  Google Scholar 

  67. McDaniel DO, Hamilton J, Brock M, et al. Molecular analysis of inflammatory markers in trauma patients at risk of postinjury complications. J Trauma. 2007;63:147–57.

    Article  CAS  PubMed  Google Scholar 

  68. Majetschak M, Obertacke U, Schade FU, et al. Tumor necrosis factor gene polymorphisms, leukocyte function, and sepsis susceptibility in blunt trauma patients. Clin Diagn Lab Immunol. 2002;9:1205–11.

    PubMed Central  CAS  PubMed  Google Scholar 

  69. Sabelnikovs O, Nikitina-Zake L, Krumina A, et al. Associations between TNF-α, IL-6 and IL-10 promoter polymorphisms and mortality in severe sepsis. J Sci Res Rep. 2012;1:17–28. Article no. JSRR.2012.002.

    Google Scholar 

  70. Tischendorf JJ, Yagmur E, Scholten D, et al. The interleukin-6 (IL6)-174 G/C promoter genotype is associated with the presence of septic shock and the ex vivo secretion of IL6. Int J Immunogenet. 2007;34:413–8.

    Article  CAS  PubMed  Google Scholar 

  71. Schlüter B, Raufhake C, Erren M, et al. Effect of the interleukin-6 promoter polymorphism (-174 G/C) on the incidence and outcome of sepsis. Crit Care Med. 2002;30:32–7.

    Article  PubMed  Google Scholar 

  72. Brattstrom O, Granath F, Rossi P, Oldner A. Early predictors of morbidity and mortality in trauma patients treated in the intensive care unit. Acta Anaesthesiol Scand. 2010;54:1007–17.

    Article  CAS  PubMed  Google Scholar 

  73. Offner PJ, Moore EE, Biffl WL. Male gender is a risk factor for major infections after surgery. Arch Surg. 1999;134:935–40.

    Article  CAS  PubMed  Google Scholar 

  74. Nydam TL, Kashuk JL, Moore EE, et al. Refractory postinjury thrombocytopenia is associated with multiple organ failure and adverse outcomes. J Trauma. 2011;70:401–6.

    Article  PubMed  Google Scholar 

  75. Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Fabian T, Paffrath T, Bouillon B, Maegele M. Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU. Crit Care. 2013;17:R42.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Rixen D, Raum M, Bouillon B, Neugebauer E. Base excess as prognostic indicator in patients with polytrauma [in German]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2002;37:347–9.

    Article  CAS  PubMed  Google Scholar 

  77. Groeneveld KM, Leenen LP, Koenderman L, Kesecioglu J. Immunotherapy after trauma: timing is essential. Curr Opin Anaesthesiol. 2011;24:219–23.

    Article  PubMed  Google Scholar 

  78. Hietbrink F, Koenderman L, Althuizen M, Pillay J, Kamp V, Leenen LP. Kinetics of the innate immune response after trauma: implications for the development of late onset sepsis. Shock. 2013;40:21–7.

    Article  CAS  PubMed  Google Scholar 

  79. Hietbrink F, Oudijk EJ, Braams R, Koenderman L, Leenen L. Aberrant regulation of polymorphonuclear phagocyte responsiveness in multitrauma patients. Shock. 2006;26:558–64.

    Article  CAS  PubMed  Google Scholar 

  80. Anne Morrison C, Moran A, Patel S, Vidaurre Mdel P, Carrick MM, Tweardy DJ. Increased apoptosis of peripheral blood neutrophils is associated with reduced incidence of infection in trauma patients with hemorrhagic shock. J Infect. 2013;66:87–94.

    Article  CAS  PubMed  Google Scholar 

  81. Warren HS, Elson CM, Hayden DL, et al. A genomic score prognostic of outcome in trauma patients. Mol Med. 2009;15:220–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  82. O’Brien PJ. Fracture fixation in patients having multiple injuries. Can J Surg. 2003;46:124–8.

    PubMed Central  PubMed  Google Scholar 

  83. Johnson JL, Moore EE, Gonzalez RJ, et al. Alteration of the postinjury hyperinflammatory response by means of resuscitation with a red cell substitute. J Trauma. 2003;54:133–9.

    Article  PubMed  Google Scholar 

  84. Ronco C, Kellum JA, Bellomo R, House AA. Potential interventions in sepsis-related acute kidney injury. Clin J Am Soc Nephrol. 2008;3:531–44.

    Article  CAS  PubMed  Google Scholar 

  85. Heeres M, Visser T, van Wessem KJ, Koenderman AH, Strengers PF, Koenderman L, Leenen LP. The effect of C1-esterase inhibitor on systemic inflammation in trauma patients with a femur fracture—the CAESAR study: study protocol for a randomized controlled trial. Trials. 2011;12:223.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  86. Spruijt NE, Visser T, Leenen LPH. A systematic review of randomized controlled trials exploring the effect of immunomodulative interventions on infection, organ failure, and mortality in trauma patients. Crit Care. 2010;14:R150.

    Article  PubMed Central  PubMed  Google Scholar 

  87. Douzinas EE, Pitaridis MT, Louris G, Andrianakis I, Katsouyanni K, Karmpaliotis D, Economidou J, Sfyras D, Roussos C. Prevention of infection in multiple trauma patients by high-dose intravenous immunoglobulins. Crit Care Med. 2000;28:8–15.

    Article  CAS  PubMed  Google Scholar 

  88. Glinz W, Grob PJ, Nydegger UE, Ricklin T, Stamm F, Stoffel D, Lasance A. Polyvalent immunoglobulins for prophylaxis of bacterial infections in patients following multiple trauma. A randomized, placebo-controlled study. Intensive Care Med. 1985;11:288–94.

    Article  CAS  PubMed  Google Scholar 

  89. Nakos G, Malamou-Mitsi VD, Lachana A, Karassavoglou A, Kitsiouli E, Agnandi N, Lekka ME. Immunoparalysis in patients with severe trauma and the effect of inhaled interferon-gamma. Crit Care Med. 2002;30:1488–94.

    Article  CAS  PubMed  Google Scholar 

  90. Dries DJ, Walenga JM, Hoppensteadt D, Fareed J. Molecular markers of hemostatic activation and inflammation following major injury: effect of therapy with IFN-gamma. J Interferon Cytokine Res. 1998;18:327–35.

    Article  CAS  PubMed  Google Scholar 

  91. Browder W, Williams D, Pretus H, Olivero G, Enrichens F, Mao P, Franchello A. Beneficial effect of enhanced macrophage function in the trauma patient. Ann Surg. 1990;211:605–12.

    PubMed Central  CAS  PubMed  Google Scholar 

  92. de Felippe Júnior J, da Rocha e Silva Júnior M, Maciel FM, Soares Ade M, Mendes NF. Infection prevention in patients with severe multiple trauma with the immunomodulator beta 1-3 polyglucose (glucan). Surg Gynecol Obstet. 1993;177:383–8.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Clinical Research, Hamad General Hospital & Clinical Medicine, Weill Cornell Medical College, Trauma Main Office, Quality Management Building, 3050, Doha, Qatar

    Ayman Ahmed El-Menyar M.D., F.R.C.P(Glasg).

  2. Department of Surgery, Clinical Research, Hamad General Hospital, Trauma Main Office, Quality Management Building, 3050, Doha, Qatar

    Mohammad Asim Ph.D.

  3. Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Trauma Main Office, Quality Management Building, 3050, Doha, Qatar

    Hassan Al-Thani M.D.

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  1. Ayman Ahmed El-Menyar M.D., F.R.C.P(Glasg).
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  2. Mohammad Asim Ph.D.
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  3. Hassan Al-Thani M.D.
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Correspondence to Ayman Ahmed El-Menyar M.D., F.R.C.P(Glasg). .

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Editors and Affiliations

  1. Department of Surgery, University of Arizona, Tucson, Arizona, USA

    Rifat Latifi

  2. Department of Surgery, The University of Arizona, Tucson, Arizona, USA

    Peter Rhee

  3. Department of Surgery, Professor of Surgery, Tucson, Arizona, USA

    Rainer W.G. Gruessner

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El-Menyar, A.A., Asim, M., Al-Thani, H. (2015). Multiorgan Dysfunction in Trauma and Surgical Intensive Care Units. In: Latifi, R., Rhee, P., Gruessner, R. (eds) Technological Advances in Surgery, Trauma and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2671-8_15

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