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SYSTEMIC RESPONSE TO

INJURY

PREPARED BY:

JOHN VINCENT A. PAGADDU


JUNIOR INTERN SPUP SCHOOL OF MEDICINE

INFLAMMATORY RESPONSE
INJURY or INFECTION
LOCAL or SYSTEMIC
PATHOGEN-associated
or DAMAGE-associated

RESTORATION
OF
HOMEOSTASIS

SURVIVAL OF SEVERELY INJURED


PATIENTS
- depends on the DEGREE and DURATION
of their dysregulated acute inflammatory
response

HOST INSULT
MINOR
localized
transient
most cases: beneficial

MAJOR
amplified reaction
systemic inflammation
remote organ damage
multiple organ failure
- 30% of severly injured patients

IMPORTANCE OF THIS TOPIC:


Systemic Inflammation is a central feature
of both sepsis and severe trauma.
To understand the complex pathways that
regulate local and systemic inflammation
To develop therapeutic intervention during
overwhelming sepsis or after severe injury.

SEPSIS and TRAUMA


SEPSIS
900,000 cases/year

TRAUMA
leading cause of mortality and
morbidity for individuals under 45
y/o.

THE DETECTION OF
CELLULAR INJURY

Mediated by Members of the DamageAssociated Molecular Pattern Family

The Role of the Immune System


What does the body do in times of injury?
TRAUMATIC INJURY
INNATE Immune
System
systemic inflammatory
response
RESTORE
HOMEOSTASIS

LIMIT DAMAGE

Systemic inflammatory response to


injury

Two General Responses:


ACUTE PROINFLAMMATORY RESPONSE
Results from innate immune system recognition
of LIGANDS

ANTIINFLAMMATORY RESPONSE
modulate the proinflammatory phase
direct a return to homeostasis

Schematic representation of the systemic inflammatory


response syndrome (SIRS) after injury, followed by a period
of convalescence mediated by the counterregulatory antiinflammatory response syndrome (CARS).
Severe inflammation may lead to acute
multiple organ failure (MOF) and early
death after injury

A lesser inflammatory response followed by


excessive CARS may induce a prolonged
immunosuppressed state that can also be
deleterious to the host

Systemic inflammatory response to


injury
Degree of the systemic inflammatory
response following trauma
proportional to injury severity
an independent predictor of subsequent
organ dysfunction and resultant mortality

Systemic Inflammatory Response


Clinical features of the injury-mediated
systemic inflammatory response:
increased body temperature
increased heart rate
increased respirations
increased WBC count

systemic inflammation following trauma is


STERILE!
likely to result from endogenous molecules that are produced as a
consequence of tissue damage or cellular stress

Clinical spectrum of infection and systemic


inflammatory response syndrome (SIRS)