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The role of mediators in the response to thermal injury

  • World Progress In Surgery
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Abstract

Inflammatory mediators play a major role in both the local burn wound and the systemic response to burn injury. Oxidant and arachidonic acid metabolites are involved in the initial burn edema process. The mediators as well as the cytokines released from activated macrophages also result in an early generalized inflammatory response. The later postburn hypermetabolism is initiated and perpetuated by these same mediators, especially the cytokines, tumor necrosis factor, interleukin-1, and interleukin-2. Circulating endotoxin from the wound or the gut also appears to be involved. The postburn septic response is now recognized to be the result of inflammation; infection is not necessary. Mediator induced priming of the inflammatory cells by the burn itself results in an exaggerated response to infection in the postburn period. Defining the specific mechanism of injury and mediators involved can result in a major improvement in burn care, especially since many mediator inhibitors are already available for clinical use. It is essential that the clinician understand this pharmacologic manipulation in order to be able to optimally utilize these future advances.

Résumé

Les médiateurs de l'inflammation jouent un rôle important dans la réponse locale et systémique des lésions par brûlures. Sont impliqués dans l'oedème réactionnel les oxydants et les métabolites de l'acide arachidonique. Les médiateurs ainsi que les cytokines libérés par les macrophages activés font petu-être partie d'une réponse inflammatoire généralisée. L'hyper métabolisme post-brûlure est provoqué et entretenu par ces mêmes médiateurs, surtout les cytokines TNF, IL-1, et IL-6. Les endotoxines circulantes provenant de la plaie ou du tube digestif peuvent être incriminées. La réponse post-brûlure septique est aussi maintenant reconnue comme étant une conséquence de l'inflammation, même en dehors de l'infection. La réaction inflammatoire cellulaire provoquée par les médiateurs résulte en une réaction exagérée à l'infection dans la période postopératoire immédiate. La définition des mécanismes spécifiques des lésions et médiateurs améliore les soins des brûlures, surtout depuis que beaucoup de médiateurs sont prêts à être utilisés en clinique. Il est essentiel que la médecin comprenne cette manipulation pharmacologique afin d'utiliser de façon optimale les progès à l'avenir.

Resumen

Los mediadores inflamatorios juegan un papel mayor tanto en los fenómenos pertinentes a la quemadura local como en los referentes a la respuesta sistémica a la lesión térmica. Los oxidantes y los metabolitos del ácido araquidónico están involucrados en el proceso inicial del edema de la quemadura. Los mediadores, así como las citocinas liberadas por los macrófagos activados, también resultan en una reacción inflamatoria generalizada precoz. El hipermetabolismo tardío de la quemadura es iniciado y perpetuado por estos mismos mediadores, especialmente las citocinas, factor necrotizante tumoral, interleucina-1 e interleucina-6. La endotoxina circulante proveniente de la quemadura o del intestino también parece estar involucrada. La respuesta séptica también se roconoce ahora como resultante de la inflamación, sin que sea necesaro que existe infección. La activación de las células inflamatorias por los mediadores resulta en una exagerada respuesta a la infección del período postquemadura. La definición de los mecanismos específicos de la lesión y de los mediadores involucrados puede resultar en avance mayor en el tratamiento de la quemaduras, especialmente teniendo en cuenta que muchos inhibidores de mediadores ya se encuentran disponibles para uso clínico. Aparece esencial que el médico comprenda esta manipulación farmacológica para que sea capaz de utilizar en forma óptima los avances que se logren en al futuro.

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Authors and Affiliations

  1. Longwood Area Trauma/Burn Center at Harvard Medical School, Boston, Massachusetts, USA

    Yeo-Kyu Youn M.D., Cheryl LaLonde B.S. & Robert Demling M.D.

  2. Seoul National University Hospital, Seoul, Korea

    Yeo-Kyu Youn M.D., Cheryl LaLonde B.S. & Robert Demling M.D.

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  1. Yeo-Kyu Youn M.D.
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  2. Cheryl LaLonde B.S.
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  3. Robert Demling M.D.
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Youn, YK., LaLonde, C. & Demling, R. The role of mediators in the response to thermal injury. World J. Surg. 16, 30–36 (1992). https://doi.org/10.1007/BF02067111

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