Impact of Head and Chest Trauma on General Condition

  • Otmar Trentz
  • Philipp M. Lenzlinger

The clinical course and outcome of the polytraumatized patient is largely determined by the severity and the pattern of injuries sustained. Blunt chest trauma and Traumatic Brain Injury (TBI) represent the two major single injury entities with the highest risk of causing complications during treatment and recovery from severe multiple injuries.


Traumatic Brain Injury Severe Traumatic Brain Injury Traumatic Brain Injury Patient Nosocomial Pneumonia Adult Respiratory Distress Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bardenheuer M, Obertacke U, Waydhas C, Nast-Kolb D. [Epidemiology of the severely injured patient. A prospective assessment of preclinical and clinical management. AG Polytrauma of DGU]. Unfallchirurg 2000;103(5):355–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Taeger G, Ruchholtz S, Waydhas C, Lewan U, Schmidt B, Nast-Kolb D. Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe. J Trauma 2005;59(2):409–16.CrossRefPubMedGoogle Scholar
  3. 3.
    Lehmann U, Rickels E, Krettek C. [Multiple trauma with craniocerebral trauma. Early definitive surgical management of long bone fractures?]. Unfallchirurg 2001;104(3):196–209.CrossRefPubMedGoogle Scholar
  4. 4.
    Lehmann U, Krettek C. [Multiple trauma with craniocerebral trauma]. Unfallchirurg 2001;104(3):195.CrossRefPubMedGoogle Scholar
  5. 5.
    Hildebrand F, Giannoudis PV, Griensven M, Zelle B, Ulmer B, Krettek C, Bellamy M, Pape H-C. Management of polytraumatized patients with associated blunt chest trauma: a comparison of two European countries. Injury 2005;36(2):293–302.CrossRefPubMedGoogle Scholar
  6. 6.
    Ertel W, Keel M, Marty D, Hoop R, Safret A, Stocker R, Trentz O. [Significance of systemic inflammation in 1,278 trauma patients]. Unfallchirurg 1998;101(7):520–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Muehlstedt SG, Richardson CJ, Lyte M, Rodriguez JL. Systemic and pulmonary effector cell function after injury. Crit Care Med 2002;30(6):1322–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Miller PR, Croce MA, Kilgo PD, Scott J, Fabian TC. Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg 2002;68(10):845–50.PubMedGoogle Scholar
  9. 9.
    Muehlstedt SG, Lyte M, Rodriguez JL. Increased IL-10 production and HLA-DR suppression in the lungs of injured patients precede the development of nosocomial pneumonia. Shock 2002;17(6):443–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Hoth JJ, Scott MJ, Owens RK, Stassen NA, Franklin GA, Cheadle WG, Rodriguez JL. Trauma alters alveolar effector cell apoptosis. Surgery 2003;134(4):631–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma 1996;40(5):764–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Cooke RS, McNicholl BP, Byrnes DP. Early management of severe head injury in Northern Ireland. Injury 1995;26(6):395–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Fearnside MR, Cook RJ, McDougall P, McNeil RJ. The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg 1993;7(3):267–79.CrossRefPubMedGoogle Scholar
  14. 14.
    McIntosh TK, Saatman KE, Raghupathi R, Graham DI, Smith DH, Lee VM, Trojanowski JQ. The Dorothy Russell Memorial Lecture. The molecular and cellular sequelae of experimental traumatic brain injury: pathogenetic mechanisms. Neuropathol Appl Neurobiol 1998;24(4):251–67.CrossRefPubMedGoogle Scholar
  15. 15.
    Marmarou A, Anderson RL, Ward JD, Choi SC, Young HF. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991;75:S59–S66.Google Scholar
  16. 16.
    Holmin S, Mathiesen T. Biphasic Edema development after experimental brain contusion in rat. Neurosci Lett 1995;194(1–2):97–100.CrossRefPubMedGoogle Scholar
  17. 17.
    Unterberg AW, Stover J, Kress B, Kiening KL. Edema and brain trauma. Neuroscience 2004;129(4):1021–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Baskaya MK, Rao AM, Dogan A, Donaldson D, Dempsey RJ. The biphasic opening of the blood-brain barrier in the cortex and hippocampus after traumatic brain injury in rats. Neurosci Lett 1997;226(1):33–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Hicks RR, Baldwin SA, Scheff SW. Serum extravasation and cytoskeletal alterations following traumatic brain injury in rats – Comparison of lateral fluid percussion and cortical impact models. Mol Chem Neuropathol 1997;32(1–3):1–16.CrossRefPubMedGoogle Scholar
  20. 20.
    Barzo P, Marmarou A, Fatouros P, Corwin F, Dunbar J. Magnetic resonance imaging monitored acute blood-brain barrier changes in experimental traumatic brain injury. J Neurosurg 1996;85(6):1113–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Fukuda K, Tanno H, Okimura Y, Nakamura M, Yamaura A. The blood-brain-barrier disruption to circulating proteins in the early period after fluid percussion brain injury in rats. J Neurotrauma 1995;12(3):315–24.CrossRefPubMedGoogle Scholar
  22. 22.
    Csuka E, Morganti-Kossmann MC, Lenzlinger PM, Joller H, Trentz O, Kossmann T. IL-10 levels in cerebrospinal fluid and serum of patients with severe traumatic brain injury: relationship to IL-6, TNF-alpha, TGF-beta1 and blood-brain barrier function. J Neuroimmunol 1999;101(2):211–21.CrossRefPubMedGoogle Scholar
  23. 23.
    Morganti-Kossmann MC, Hans VHJ, Lenzlinger PM, Dubs R, Ludwig F, Trentz O, Kossmann T. TGF-beta is elevated in the CSF of patients with severe traumatic brain injuries and parallels blood-brain barrier function. J Neurotrauma 1999;16(7):617–28.CrossRefPubMedGoogle Scholar
  24. 24.
    Pleines UE, Stover JF, Kossmann T, Trentz O, Morganti-Kossmann MC. Soluble ICAM-1 in CSF coincides with the extent of cerebral damage in patients with severe traumatic brain injury. J Neurotrauma 1998;15(6):399.CrossRefPubMedGoogle Scholar
  25. 25.
    Soares HD, Hicks RR, Smith D, McIntosh TK. Inflammatory leukocytic recruitment and diffuse neuronal degeneration are separate pathological processes resulting from traumatic brain injury. J Neurosci 1995;15(12):8223–33.PubMedGoogle Scholar
  26. 26.
    Zhuang J, Shackford SR, Schmoker JD, Anderson ML. The association of leukocytes with secondary brain injury. J Trauma 1993;35(3):415–22.CrossRefPubMedGoogle Scholar
  27. 27.
    Carlos TM, Clark RSB, FranicolaHiggins D, Schiding JK, Kochanekt PM. Expression of endothelial adhesion molecules and recruitment of neutrophils after traumatic brain injury in rats. J Leukoc Biol 1997;61(3):279–85.PubMedGoogle Scholar
  28. 28.
    Isaksson J, Lewen A, Hillered L, Olsson Y. Up-regulation of intercellular adhesion molecule 1 in cerebral microvessels after cortical contusion trauma in a rat model. Acta Neuropathol 1997;94(1):16–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Shibayama M, Kuchiwaki H, Inao S, Yoshida K, Ito M. Intercellular adhesion molecule-1 expression on glia following brain injury: participation of interleukin-1 beta. J Neurotrauma 1996;13(12):801–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Rancan M, Otto VI, Hans VH, Gerlach I, Jork R, Trentz O, Kossmann T, Morganti-Kossmann MC. Upregulation of ICAM-1 and MCP-1 but not of MIP-2 and sensorimotor deficit in response to traumatic axonal injury in rats. J Neurosci Res 2001;63(5):438–46.CrossRefPubMedGoogle Scholar
  31. 31.
    Holmin S, Soderlund J, Biberfeld P, Mathiesen T. Intracerebral inflammation after human brain contusion. Neurosurgery 1998;42(2):291–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Holmin S, Mathiesen T, Shetye J, Biberfeld P. Intracerebral inflammatory response to experimental brain contusion. Acta Neurochir (Wien) 1995;132(1–3):110–9.CrossRefGoogle Scholar
  33. 33.
    Morganti-Kossman MC, Lenzlinger PM, Hans V, Stahel P, Csuka E, Ammann E, Stocker R, Trentz O, Kossmann T. Production of cytokines following brain injury: beneficial and deleterious for the damaged tissue. Mol Psychiatry 1997;2(2):133–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Hans VH, Kossmann T, Lenzlinger PM, Probstmeier R, Imhof HG, Trentz O & Morganti-Kossmann MC. Experimental axonal injury triggers interleukin-6 mRNA, protein synthesis and release into cerebrospinal fluid. J Cereb Blood Flow Metab 1999;19(2):184–94.CrossRefPubMedGoogle Scholar
  35. 35.
    Ott L, McClain CJ, Gillespie M, Young B. Cytokines and metabolic dysfunction after severe head-injury. J Neurotrauma 1994;11(5):447–72.CrossRefPubMedGoogle Scholar
  36. 36.
    Rothwell NJ, Hopkins SJ. Cytokines and the nervous-system. 2. Actions and mechanisms of action. Trends Neurosci 1995;18(3):130–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Lenzlinger PM, Morganti-Kossmann MC, Laurer HL, McIntosh TK. The duality of the inflammatory response to traumatic brain injury. Mol Neurobiol 2001;24(1–3):169–81.PubMedGoogle Scholar
  38. 38.
    Bratton SL, Davis RL. Acute lung injury in isolated traumatic brain injury. Neurosurgery 1997;40(4):707–12.CrossRefPubMedGoogle Scholar
  39. 39.
    Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA, Patel R, Erickson VR, Pittet JF. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma 2003;55(1):106–11.CrossRefPubMedGoogle Scholar
  40. 40.
    Berthiaume L, Zygun D. Non-neurologic organ dysfunction in acute brain injury. Crit Care Clin 2006;22(4):753–66.CrossRefPubMedGoogle Scholar
  41. 41.
    Bahloul M, Chaari AN, Kallel H, Khabir A, Ayadi A, Charfeddine H, Hergafi L, Chaari AD, Chelly HE, Ben Hamida C, Rekik N, Bouaziz M. Neurogenic pulmonary edema due to traumatic brain injury: evidence of cardiac dysfunction. Am J Crit Care 2006;15(5):462–70.PubMedGoogle Scholar
  42. 42.
    Simon RP. Neurogenic pulmonary-edema. Neurol Clin 1993;11(2):309–23.PubMedGoogle Scholar
  43. 43.
    Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiol Scand 2007;51(4):447–55.CrossRefPubMedGoogle Scholar
  44. 44.
    Kalsotra A, Zhao J, Anakk S, Dash PK, Strobel HW. Brain trauma leads to enhanced lung inflammation and injury: evidence for role of P4504Fs in resolution. J Cereb Blood Flow Metab 2007;27(5):963–74.PubMedGoogle Scholar
  45. 45.
    Piek J, Chesnut RM, Marshall LF, van Berkum-Clark M, Klauber MR, Blunt BA, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. Extracranial complications of severe head-injury. J Neurosurg 1992;77(6):901–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Cazzadori A, DiPerri G, Vento S, Bonora S, Fendt D, Rossi M. Aetiology of pneumonia following isolated closed head injury. Respir Med 1997;91(4):193–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Loop T. The immune system: basic principles and modulation by anaesthetics. Anasthesiol & Intensivmed 2003;44(1):53–65.Google Scholar
  48. 48.
    Loop T, Humar M, Pischke S, Hoetzel A,Schmidt R, Pahl HL, Geiger KK, Pannen BH. Thiopental inhibits tumor necrosis factor alpha-induced activation of nuclear factor kappa B through suppression of I kappa B kinase activity. Anesthesiology 2003;99(2):360–7.Google Scholar
  49. 49.
    Harris OA, Colford JM, Good MC, Matz PG. The role of hypothermia in the management of severe brain injury. A meta-analysis. Arch Neurol 2002;59(7):1077–83.CrossRefPubMedGoogle Scholar
  50. 50.
    Dujardin KS, McCully RB, Wijdicks EFM, Tazelaar HD Seward JB, McGregor CGA, Olson LJ. Myocardial dysfunction associated with brain death: clinical, echocardiographic, and pathologic features. J Heart Lung Transplant 2001;20(3):350–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Connor RCR. Myocardial damage secondary to brain lesions. Am Heart J 1969;78(2):145–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Stein SC, Smith DH. Coagulopathy in traumatic brain injury. Neurocrit Care 2004;1(4):479–88.CrossRefPubMedGoogle Scholar
  53. 53.
    Kearney TJ, Bentt L, Grode M, Lee S, Hiatt JR, Shabot MM. Coagulopathy and catecholamines in severe head-injury. J Trauma 1992;32(5):608–12.CrossRefPubMedGoogle Scholar
  54. 54.
    Lenzlinger PM, Hans VH, Joller-Jemelka HI, Trentz O, Morganti-Kossmann MC, Kossmann T. Markers for cell-mediated immune response are elevated in cerebrospinal fluid and serum after severe traumatic brain injury in humans. J Neurotrauma 2001;18(5):479–89.CrossRefPubMedGoogle Scholar
  55. 55.
    Quattrocchi KB, Frank EH, Miller CH, Amin A, Issel BW, Wagner FC. Impairment of helper T-cell function and lymphokine-activated killer cytotoxicity following severe head-injury. J Neurosurg 1991;75(5):766–73.CrossRefPubMedGoogle Scholar
  56. 56.
    Quattrocchi KB, Issel BW, Miller CH, Frank EH, Wagner FC. Impairment of helper T-cell function following severe head-injury. J Neurotrauma 1992;9(1):1–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Quattrocchi KB, Miller CH, Wagner FC, DeNardo SJ, DeNardo GL, Ovodov K, Frank EH. Cell-mediated-immunity in severely head-injured patients – the role of suppressor lymphocytes and serum factors. J Neurosurg 1992;77(5):694–9.CrossRefPubMedGoogle Scholar
  58. 58.
    Hans VH, Kossmann T, Joller H, Otto V, Morganti-Kossmann MC. Interleukin-6 and its soluble receptor in serum and cerebrospinal fluid after cerebral trauma. Neuroreport 1999;10(2):409–12.CrossRefPubMedGoogle Scholar
  59. 59.
    Bell MJ, Kochanek PM, Doughty LA, Carcillo JA, Adelson PD, Clark RS, Wisniewski SR, Whalen MJ, DeKosky ST. Interleukin-6 and interleukin-10 in cerebrospinal fluid after severe traumatic brain injury in children. J Neurotrauma 1997;14(7):451–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Kossmann T, Hans VH, Imhof HG, Stocker R, Grob P, Trentz O, Morganti-Kossmann C. Intrathecal and serum interleukin-6 and the acute-phase response in patients with severe traumatic brain injuries. Shock 1995;4(5):311–7.CrossRefPubMedGoogle Scholar
  61. 61.
    Kossmann T, Stahel PF, Lenzlinger PM, Redl H, Dubs RW, Trentz O, Schlag G, Morganti-Kossmann MC. Interleukin-8 released into the cerebrospinal fluid after brain injury is associated with blood-brain barrier dysfunction and nerve growth factor production. J Cereb Blood Flow Metab 1997;17(3):280–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Whalen MJ, Carlos TM, Kochanek PM, Wisniewski SR, Bell MJ, Clark RS, DeKosky ST, Marion DW, Adelson PD. Interleukin-8 is increased in cerebrospinal fluid of children with severe head injury. Crit Care Med 2000;28(4):929–34.CrossRefPubMedGoogle Scholar
  63. 63.
    Woiciechowsky C, Schoning B, Lanksch WR, Volk HD, Docke WD. Mechanisms of brain-mediated systemic anti-inflammatory syndrome causing immunodepression. J Mol Med 1999;77(11):769–80.CrossRefPubMedGoogle Scholar
  64. 64.
    Kulshrestha P, Munshi I, Wait R. Profile of chest trauma in a Level I trauma center. J Trauma 2004;57(3):576–81.CrossRefPubMedGoogle Scholar
  65. 65.
    Trupka A, Nast-Kolb D, Schweiberer L. Blunt chest trauma. Unfallchirurg 1998;101(4):244–58.CrossRefPubMedGoogle Scholar
  66. 66.
    Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 2000;49(3):496–504.CrossRefPubMedGoogle Scholar
  67. 67.
    Miller PR, Croce MA, Bee TK, Qaisi WG, Smith CP, Collins GL, Fabian TC. ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma 2001;51(2):223–30.CrossRefPubMedGoogle Scholar
  68. 68.
    Segers P, Van Schil P, Jorens P, Van Den Brande F. Thoracic trauma: an analysis of 187 patients. Acta Chir Belg 2001;101(6):277–82.PubMedGoogle Scholar
  69. 69.
    Sariego J, Brown JL, Matsumoto T, Kerstein MD. Predictors of pulmonary complications in blunt chest trauma. Int Surg 1993;78(4):320–3.PubMedGoogle Scholar
  70. 70.
    Muehlstedt SG, Richardson CJ, West MA, Lyte M, Rodriguez JL. Cytokines and the pathogenesis of nosocomial pneumonia. Surgery 2001;130(4):602–9.CrossRefPubMedGoogle Scholar
  71. 71.
    Perl M, Gebhard F, Bruckner UB, Ayala A, Braumuller S, Buttner C, Kinzl L, Knoferl MW. Pulmonary contusion causes impairment of macrophage and lymphocyte immune functions and increases mortality associated with a subsequent septic challenge. Crit Care Med 2005;33(6):1351–8.CrossRefPubMedGoogle Scholar
  72. 72.
    Perl M, Gebhard F, Braumuller S, Tauchmann B, Bruckner UB, Kinzl L, Knoferl MW. The pulmonary and hepatic immune microenvironment and its contribution to the early systemic inflammation following blunt chest trauma. Crit Care Med 2006;34(4):1152–9.CrossRefPubMedGoogle Scholar
  73. 73.
    Michaels AJ. Management of post traumatic respiratory failure. Crit Care Clin 2004;20(1):83–99.CrossRefPubMedGoogle Scholar
  74. 74.
    Cuthbertson DP. Post-shock metabolic response. Lancet 1942;1:433–7.CrossRefGoogle Scholar
  75. 75.
    Bosse MJ, MacKenzie EJ, Riemer BL, Brumback RJ, McCarthy ML, Burgess AR, Gens DR, Yasui Y. Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate – A comparative study. J Bone Joint Surg Am 1997;79A(6):799–809.Google Scholar
  76. 76.
    Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma – flail chest vs pulmonary contusion. J Trauma 1988;28(3):298–304.CrossRefPubMedGoogle Scholar
  77. 77.
    Johnson JA, Cogbill TH, Winga ER. Determinants of outcome after pulmonary contusion. J Trauma 1986;26(8):695–7.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryUniversity Hospital ZürichZürichSwitzerland

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