Abstract
Trauma is still the major cause of death and severe disabilities both in developing and industrialized countries. Severe trauma promotes a hyperinflammatory condition able to lead to a condition of organ(s) dysfunction known as multiple organ dysfunction syndrome (MODS), which in a continuum might end to multiple organ failure (MOF) and in worst cases death. Opposite inflammatory and anti-inflammatory responses are simultaneously present after trauma, leading to (multiple) organ dysfunction(s). The definition of MOF is still a matter of debate, and scores to grade its severity (MODS, SOFA, Denver score) are used with quite different results according to their sensibility and specificity. Harmonization of the scores and shared definitions appears mandatory to overcome this problem. Risk factors for MOF are male sex, age, obesity, severity of injury, units of red blood cells (RBCs) transfused within the first 12 h, and acidosis. As for infections, in trauma innate and adaptive responses are triggered by alarmins and damage-associated molecular patterns (DAMPs), recognized by components of innate and acquired immunity (mainly Toll-like receptors, TLRs): TLRs are able to transduce signals in response to alarmins and DAMPs and to activate several signal pathways, making these molecules the possible link between SIRS, inflammation, and trauma. Prevention of major dysfunctions of the cardiovascular, respiratory, and renal systems remains the mainstay strategy, mainly based on early, adequate, aggressive supportive measures.
It is important to remember that SIRS, MODS, MOF[…] are terms with arbitrary definitions that cannot be treated as such. The specific underlying diseases causing these conditions must be identified and treated while organ function is supported……. The whole problem of organ failure continues to perplex clinicians and scientists, and it contributes to fatal outcomes for patients with illnesses, infections, and injuries after operations. We know a lot about these problems but frequently can do little. The best approach remains patient and organ support to prevent failure
Arthur E Baue
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DeGasperi, A., Bucci, L., Wahlen, B.M. (2019). Multiple Organ Dysfunction Syndrome After Trauma: Update 2017. In: Aseni, P., De Carlis, L., Mazzola, A., Grande, A.M. (eds) Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95114-0_50
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