Novel concepts related to inflammatory complications in polytrauma

Excerpt

The management of critically injured polytrauma patients defines our speciality and provides us never-ending challenges. Historically, the unachievable goal was to avoid early and frequently prehospital deaths [1]. With the advancement of prehospital medicine and evidence-based improvements in trauma care, polytrauma mortality decreased below 10% in developed trauma systems, with very little to no preventable mortality margin for hospital-based medical management [2]. We navigate our patients with catastrophic injuries and deranged physiology through the initial resuscitation phase and find them on intensive care units in pathophysiological states, which the human body and the treating doctors have not experienced before. Polytrauma is a changing disease due to ageing populations with co-morbidities, different and hopefully less iatrogenic interventions, faster paced overall care, use of modern technology and current expectations on quality of life. Early survivors of polytrauma remain at high risk for major inflammatory response driven complications such as organ dysfunctions, multiple organ failure, sepsis, venous thromboembolism and persistent inflammation catabolism syndrome. Beyond extended intensive care unit stay and late hospital mortality, these conditions are major determinants of long-term functional outcomes, independent of the initial injury severity. …