Multivariable Physiologic Monitoring as a Guide to the Severity and Appropriate Therapy of Posttrauma ICU Patients

  • J. H. Siegel
  • D. Rixen


Clinical care and therapeutic decision making in the severely injured patient whose course is complicated by shock, sepsis or one of the various organ failure syndromes has been complicated by a lack of a precise methodology of classification of the nature of these disease processes and stratification of their severity. One important additional consequence of the lack of an effective methodology for stratification of critically ill patients with posttraumatic and/or septic syndromes into groups of homogeneous severity has been the paucity of significant advances in basic science mechanisms linking the production of various shock mediators to the different categories of the human host defense response. As a therapeutic consequence, the results of recent human clinical trials where a variety of antiendotoxin or anticytokine mediators have been tested in the therapy of sepsis have been either disappointing or equivocal in their outcome.


Systemic Inflammatory Response Syndrome Mean Arterial Blood Pressure Sepsis Syndrome Host Defense Response Systemic Inflammatory Response Syndrome Criterion 
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.
    Bone RC, Fisher CJ, Clemmer TP et al (1989) Sepsis syndrome: a valid clinical entity. Crit Care Med 17:389–392PubMedCrossRefGoogle Scholar
  2. 2.
    Bone RC and Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidehnes for the use of innovative therapies in sepsis. Crit Care Med 20:864–874Google Scholar
  3. 3.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  4. 4.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1986) An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 104:410–418PubMedGoogle Scholar
  5. 5.
    Giangiuliani G, Mancini A, Gui D (1989) Vahdation of a severity of illness score (APACHE II) in a surgical intensive care unit. Intensive Care Med 15:519–522PubMedCrossRefGoogle Scholar
  6. 6.
    Cerra FB, Negro F, Abrams J (1990) APACHE II score does not predict multiple organ failure or mortality in post operative surgical patients. Ann Surg 125:519–522Google Scholar
  7. 7.
    Siegel JH, Rixen D, Friedman H (1995) Physiologic classification and stratification of illness severity of posttrauma “sepsis” patients as a basis for randomization of clinical trials. J Endotoxin Res 2:177–188Google Scholar
  8. 8.
    Ziegler EJ, Fisher CH, Sprung CL et al (1991) Treatment of gram-negative bacteremia and septic shock with HA-IA human monoclonal antibody against endotoxin — a randomized, double blind, placebo-controlled trial. N Engl J Med 324:429–436PubMedCrossRefGoogle Scholar
  9. 9.
    Hinshaw L and The Veterans Administration Systemic Sepsis Cooperative Study Group (1987) Effect of high-dose glucocorticoid therapy on mortality in pafients with clinical signs of systemic sepsis. N Engl J Med 317:659–665CrossRefGoogle Scholar
  10. 10.
    Siegel JH, Goodzari S, Coleman WP et al (1993) Qualifying the severity of the human response to injury and sepsis as a guide to the interpretafion of pathophysiologic cytokine effects. In: Schlag G, Redl H, Traber D (eds) Third Wiggers Bernard Conference on Shock, Sepsis and Organ Failure. Springer, Berlin Heidelberg New York, pp 163–204Google Scholar
  11. 11.
    Rixen D, Siegel JH, Friedman HP (1995) “Sepsis/SIRS”, physiologic classification, severity strafification, relation to cytokine elaborafion and outcome prediction in posttrauma critical illness. J Trauma (submitted for pubhcation)Google Scholar
  12. 12.
    Rixen D, Siegel JH, Friedman H (1995) Physiologic state severity classification as an indicator of posttrauma cytokine response. Shock 4:27–38PubMedCrossRefGoogle Scholar
  13. 13.
    Rixen D, Siegel JH, Bertolini M, Espina N (1995) Histamine, cytokine and metabolic relationships in posttrauma critical illness. Surgery (submitted for publication)Google Scholar
  14. 14.
    Rixen D, Siegel JH, Espina N, Bertolini M, Friedman HP (1995) Nitric oxide production as a correlate of sepsis and the severity of the physiologic state of the host defense in posttrauma critical illness (1995). J Trauma (submitted for pubhcation)Google Scholar

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© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • J. H. Siegel
  • D. Rixen

There are no affiliations available

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