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Clinical review: immunodepression in the surgical patient and increased susceptibility to infection.

Angele MK, Faist E - Crit Care (2002)

Bottom Line: Furthermore, the effect of those mediators on cell-mediated immune responses has been studied.This article will focus on the effect of blood loss and surgical injury on cell-mediated immune responses in experimental studies utilizing models of trauma and hemorrhagic shock, which have defined effects on the immunoinflammatory response.Subsequently these findings will be correlated with data generated from surgical patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.

ABSTRACT
Several studies indicate that organ failure is the leading cause of death in surgical patients. An excessive inflammatory response followed by a dramatic paralysis of cell-mediated immunity following major surgery appears to be responsible for the increased susceptibility to subsequent sepsis. In view of this, most of the scientific and medical research has been directed towards measuring the progression and inter-relationship of mediators following major surgery. Furthermore, the effect of those mediators on cell-mediated immune responses has been studied. This article will focus on the effect of blood loss and surgical injury on cell-mediated immune responses in experimental studies utilizing models of trauma and hemorrhagic shock, which have defined effects on the immunoinflammatory response. Subsequently these findings will be correlated with data generated from surgical patients. The results of these studies may generate new approaches for the treatment of immunodepression following major surgery, thus reducing the susceptibility to infection and increasing the survival rate of the critical ill surgical patient.

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Hypothesis of the cascade of events following major surgery that lead to the development of depressed immune responses and increased susceptibility to sepsis. TGF-β, transforming growth factor β ; TNF-α, tumor necrosis factor α.
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Figure 2: Hypothesis of the cascade of events following major surgery that lead to the development of depressed immune responses and increased susceptibility to sepsis. TGF-β, transforming growth factor β ; TNF-α, tumor necrosis factor α.

Mentions: An association between the loss of immunocompetence (paralysis of the cell-mediated immunity) in patients following traumatic injury, and the development of sepsis and late death has been reported [16,17] (Fig. 2). Furthermore, alterations in the levels of circulating E-selectin adhesion molecules after trauma and resuscitation have been found to be associated with an increased risk for infections complications, organ failure, and death [69]. In summary, these studies suggest that the immunodepression following injury and major surgery leads to an increased susceptibility to polymi-crobial sepsis. Therefore, attempts to modulate the depressed immune responses in trauma victims might decrease the development of septic complications and multiple organ failure in those patients.


Clinical review: immunodepression in the surgical patient and increased susceptibility to infection.

Angele MK, Faist E - Crit Care (2002)

Hypothesis of the cascade of events following major surgery that lead to the development of depressed immune responses and increased susceptibility to sepsis. TGF-β, transforming growth factor β ; TNF-α, tumor necrosis factor α.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC137309&req=5

Figure 2: Hypothesis of the cascade of events following major surgery that lead to the development of depressed immune responses and increased susceptibility to sepsis. TGF-β, transforming growth factor β ; TNF-α, tumor necrosis factor α.
Mentions: An association between the loss of immunocompetence (paralysis of the cell-mediated immunity) in patients following traumatic injury, and the development of sepsis and late death has been reported [16,17] (Fig. 2). Furthermore, alterations in the levels of circulating E-selectin adhesion molecules after trauma and resuscitation have been found to be associated with an increased risk for infections complications, organ failure, and death [69]. In summary, these studies suggest that the immunodepression following injury and major surgery leads to an increased susceptibility to polymi-crobial sepsis. Therefore, attempts to modulate the depressed immune responses in trauma victims might decrease the development of septic complications and multiple organ failure in those patients.

Bottom Line: Furthermore, the effect of those mediators on cell-mediated immune responses has been studied.This article will focus on the effect of blood loss and surgical injury on cell-mediated immune responses in experimental studies utilizing models of trauma and hemorrhagic shock, which have defined effects on the immunoinflammatory response.Subsequently these findings will be correlated with data generated from surgical patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.

ABSTRACT
Several studies indicate that organ failure is the leading cause of death in surgical patients. An excessive inflammatory response followed by a dramatic paralysis of cell-mediated immunity following major surgery appears to be responsible for the increased susceptibility to subsequent sepsis. In view of this, most of the scientific and medical research has been directed towards measuring the progression and inter-relationship of mediators following major surgery. Furthermore, the effect of those mediators on cell-mediated immune responses has been studied. This article will focus on the effect of blood loss and surgical injury on cell-mediated immune responses in experimental studies utilizing models of trauma and hemorrhagic shock, which have defined effects on the immunoinflammatory response. Subsequently these findings will be correlated with data generated from surgical patients. The results of these studies may generate new approaches for the treatment of immunodepression following major surgery, thus reducing the susceptibility to infection and increasing the survival rate of the critical ill surgical patient.

Show MeSH
Related in: MedlinePlus