Elsevier

Injury

Volume 41, Issue 1, January 2010, Pages 21-26
Injury

Review
Current theories on the pathophysiology of multiple organ failure after trauma

https://doi.org/10.1016/j.injury.2009.07.010Get rights and content

Abstract

Despite the enormous efforts to elucidate the mechanisms of the development of multiple organ failure (MOF) following trauma, MOF following trauma is still a leading cause of late post-injury death and morbidity. Now, it has been proven that excessive systemic inflammation following trauma participates in the development of MOF. Fundamentally, the inflammatory response is a host-defence response; however, on occasion, this response turns around to cause deterioration to host depending on exo- and endogenic factors. Through this review we aim to describe the pathophysiological approach for MOF after trauma studied so far and also introduce the prospects of this issue for the future.

Introduction

The biological immune response to trauma is a host-defence response. The process of inflammatory reaction to trauma involves mediators (cytokines, chemokines, complement, oxygen radical, eicosanoid and nitric oxide (NO)) and effector cells (neutrophil, monocytes/macrophages and endothelial cells). All these factors are interrelated and interconnected by up-regulatory and down-regulatory mechanisms, which lead to systemic inflammatory response syndrome (SIRS). However, uncontrolled systemic inflammation and imbalance of the production of these inflammatory factors as the result of massive systemic immunological activation after severe trauma results in organ dysfunction. The level of immunological alteration which leads to SIRS in the wake of multiple organ failure (MOF) is regulated by the degree of injury, the type of injured tissue, age, sex, polymorphism and physical condition (exo- and endogenic factors). The purpose of this review is to highlight our current knowledge on the pathophysiology of MOF after trauma.

Section snippets

Cytokines

The cytokine response is an important factor in the development of SIRS; during SIRS, pro-inflammatory cytokines (IL-1, TNF-α, IL-6, IL-8, IL-12, IL-18, G-CSF and GM-CSF) are released excessively. With the release of pro-inflammatory cytokines during the initial phase of trauma anti-inflammatory cytokines, including IL-1Ra, IL-4, IL-10, IL-11 and IL-13 are released. The role of the anti-inflammatory cytokines is to down-regulate the production of pro-inflammatory cytokines. Normally, the

Conclusion

The pathogenesis of posttraumatic complications such as SIRS, ARDS and MOF remains incompletely understood. There have been numerous efforts to elucidate the mechanisms of SIRS, ARDS and MOF. These studies revealed that cells of the immune system (PMNs, lymphocytes, monocytes/macrophages, dendritic cells and endothelial cells) and the release of pro- and anti-inflammatory cytokines, chemokines, adhesion molecules, complement, protease, eicosanoids, ROS and NO are involved in these complications

Conflict of interest

There is no conflict of interest on our manuscript.

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