Immune Consequences Of Trauma Shock And Sepsis

Sepsis and infection are the major enemies of the intensive care patient in whom immunological defenses are severely impaired. This major problem is thefocus of attention in this book, based on the presentation of the First International Congress on the Immune Consequences of Trauma, Shock, and Sepsis, which is one of the first attempts to exchange ideas on the state-of-the-art in this area of immunology. Both basic and clinical research, including new centres of attention, are described. The growing role of immunology in medicine opens new avenues to the under- standing of trauma and sepsis and will allow the design of novel therapeutic approaches.

This book presents a unique overview of all aspects of host defense alterations under stressful conditions. It is based on the most important contributions given at the "2nd International Congress on the Immune Consequences of Trauma, Shock, and Sepsis-Mechanisms and Therapeutic Approaches," which was held in Munich under the auspices of the most distinguished scientific societies involved in this field (Society of Critical Care Medicine, European Society of Intensive Care Medicine, Societe Internationale de Chirurgie, Surgical Infection Society, Surgical Infection Society Europe, European Society for Surgical Research, International Society for Burn Injury, American Association for the Surgery of Trauma, and National Institutes of Health). Since the first conference of this kind in 1988, new information from basic studies and clinical trials has provided exciting and novel insights into the immune dysfunctions accom panying trauma, shock, and sepsis. The volume is divided into 18 parts presenting the structural background of trauma-induced alterations of immune and imflammatory mechanisms as well as the currently discussed therapeutic interventions designed to restore or maintain normal host defenses following major injury. Introducing the general theme of the book is a summary of the essential keystones of trauma and sepsis-related immune deficits. Discussions of the progress in trauma care brought through better understanding of the cell biology of injury and of the major clinical factors that influence host defense integrity in operative medicine provide a setting for understanding the wide array of detailed information that is presented thereafter.

This book presents a unique overview of all aspects of host defense alterations under stressful conditions. It is based on the most important contributions given at the "2nd International Congress on the Immune Consequences of Trauma, Shock, and Sepsis-Mechanisms and Therapeutic Approaches," which was held in Munich under the auspices of the most distinguished scientific societies involved in this field (Society of Critical Care Medicine, European Society of Intensive Care Medicine, Societe Internationale de Chirurgie, Surgical Infection Society, Surgical Infection Society Europe, European Society for Surgical Research, International Society for Burn Injury, American Association for the Surgery of Trauma, and National Institutes of Health). Since the first conference of this kind in 1988, new information from basic studies and clinical trials has provided exciting and novel insights into the immune dysfunctions accom panying trauma, shock, and sepsis. The volume is divided into 18 parts presenting the structural background of trauma-induced alterations of immune and imflammatory mechanisms as well as the currently discussed therapeutic interventions designed to restore or maintain normal host defenses following major injury. Introducing the general theme of the book is a summary of the essential keystones of trauma and sepsis-related immune deficits. Discussions of the progress in trauma care brought through better understanding of the cell biology of injury and of the major clinical factors that influence host defense integrity in operative medicine provide a setting for understanding the wide array of detailed information that is presented thereafter.

This book contains a unique overview of the sequence of steps of host defense impairment that result from injury and lead to multiple organ dysfunction syndrome. The crucial alterations of immune and inflammatory mechanisms as they are seen during ischemia, during inter- mediate inflammatory phases, and in states of bacterial sepsis are described in detail. The role of endotoxin, its mechanisms of action, and potential counterregulatory strategies to neutralize endotoxin in order to protect from shock are discussed, as there are major etiologic factors leading to organ failure such as hepatic cellular injury and bacterial translocation. Cytokines, as the central mediators in acute phase states and the modulation of cytokine action are then evaluated carefully. In the discussion of the clinical aspects of multiple organ failure, the antibiotic interactions with host defenses, the augmentation of immunoreactivity with special nutrients and the newest insights into the regulation of wound repair are elucidated. The final sections of this book deal with therapeutic immunomodulatory approaches for the prevention ofinfections and with interventional strategies in the therapy of septic shock.

This book is the result of the 3rd Wiggers Bernard Conference. The Wiggers Bernard Conferences, named after two great physiologists of the past, are biannual gatherings of the leaders in the field of shock. The meetings focus on specific areas of interest, where a lot of new informations is available, but needs to be focused. There are informal presentations during which the seminarian can be intenupted in order to clarify a pat1icular point; formal discussions follow each presentation; these are followed by infOlmal gatherings in which these discussion continue in a very relaxed environment. The 1992 meeting took place in Obermayerhofen, a small but charming castle in the soft green hills of Eastern Styria in the South-Eastern part of Austria. The castle was built in 1130, restored and turned into a hotel in 1977. The renaissance court yard and the generous and exclusive decors make it one of the most beautiful castles in Austria. The frank beauty and hospitality of this area acted as a catalyst to crystalize the thoughts of this interdisciplinary group of scientists as they discussed new findings in the cytokine area.

In this book current knowledge of the pathophysiology of shock, sepsis and multi organ failure is presented. The rapid progress which has been made and the results achieved in intensive care medicine are based on sound basic research, which is duly reflected in these chapters. Multiorgan failure is the foremost cause of postoperative and posttraumatic death and many complex mechanisms are involved. Only with a good foundation of basic research can abnormalities in the physiological, biochemical, and morphological course of shock be recognized and the necessary conclusions for treatment drawn. Therapy must proceed from profound knowledge of the multi variant physiological events in order to influence shock, sepsis and organ failure. Although numerous possibilities for therapy have arisen from pharmaceutical research in recent years, they are beyond the scope of this book and are not discussed here. To gain a better understanding of the pathophysiological events it was necessary to examine and to describe different models that simulate and reproduce these events. Here we describe the causative agents (shock) and the consequences (sepsis, organ failure) in two main sections, divided on the basis of their pathophysiology.