The systematic inflammatory response after major trauma]

Few investigations have elucidated the acute inflammatory response after accidental trauma before the patients were anesthetized and treated with analgetics and intravenous fluid. The cellular immunological response seems to be characterized by an initial activation followed by suppression. In major tissue trauma, the granulocytes are the major effector cells. Activated granulocytes are redistributed from the peripheral blood into the tissues, where release of proteolytic enzymes and oxygen-free radicals participate in the development of systemic inflammation and organ dysfunction. The antigen presentation capacity of monocytes and the cytotoxicity of NK-cells are reduced following major trauma. High concentrations of proinflammatory and antiinflammatory cytokines can be measured locally in the injured tissue. In uncomplicated cases, elevated cytokine concentrations are measured in the blood for a few days, whereas a sustained high cytokine production seems to correlate with organ dysfunction and mortality.