Organ failure after trauma: synergism between the immune system and tissue factors.
Trauma or injury is the most important cause of dead for people under the age of 50 in the Western world. An important part of this mortality (50%) is due to organ failure in tissues not directly affected by the initial trauma. When this organ failure develops, multiple organs can loose their function by an excessive innate immune response or severe infection (sepsis). Once symptoms of organ failure have manifested, there lacks an adequate treatment. Prevention of organ failure is therefore essential for a reduction in mortality after injury.
All types of injury give an inflammatory reaction, thus surgical intervention can have an additional effect in the development of organ failure after trauma. In general, direct complete surgical treatment of traumapatients gives good results with less complications by the trauma itsself. However, recently it has been shown that minimal operative burden or postponing surgery if favoured in patients with an excessive immunological response. Which patient needs which treatment regime (early total care or damage control) is still under debate. De risk stratification for the amount of trauma, and thus the amount of inflammation, is done by the clinical eye of the supervising surgeon. For increasing the level of patient care a more objective risk stratification, i.e. immunological parameters, are needed. However, the largely lack of our knowledge about the pathophysiology of organ failure after trauma prevents this.
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This current project aims at identifying the pathophysiological
processes after trauma that lead to organ failure. Neutrophils (PMNs;
cells of the innate immune system) play a central role in the development
of organ failure, but have only been given limited attention and research.
We have been able to show that these cells are involved in both organ
failure by excessive inflammation as organ failure by sepsis. We have
constructed receptor expression profiles to quantify the amount of neutrophil
activation and thus the inflammatory state of the patient.
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In our first study, 120 patients receiving intramedullary osteosynthesis, a risk factor for ARDS (pulmonary organ failure) are included. ARDS is a frequent neutrophil mediated complication after trauma. By performing this intramedullary osteosynthesis, the surgeon add to the development of ARDS. The influence of the initial trauma and the adding effect of the surgeon to the inflammation is analyzed . |
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In the second study, a relation between dysfunctional neutrophils and the development of sepsis is investigated. For this, 50 surgical ICU patients are included. |
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For more information you can contact:
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Falco Hietbrink |