Cytokine Patterns in Patients After Major Vascular Surgery, Hemorrhagic Shock, and Severe Blunt Trauma Relation with Subsequent Adult Respiratory Distress Syndrome and Multiple Organ Failure

Abstract

ObjectiveThis study investigates the course of serum cytokine levels in patients with multiple trauma, patients with a ruptured abdominal aortic aneurysm (AAA), and patients undergoing elective AAA repair and the relationship of these cytokines to the development of adult respiratory distress syndrome (A R D S) and multiple organ failure (MOF). Summary Background DataSevere tissue trauma, hemorrhagic shock, and ischemia-reperfusion injury are pathophysiologic mechanisms that may result in an excessive uncontrolled activation of inflammatory cells and mediators. This inflammatory response is thought to play a key role in the development of (remote) cell and organ dysfunction, which is the basis of A R D S and MOF. MethodsThe study concerns 28 patients with multiple trauma, 20 patients admitted in shock because of a ruptured AAA, and 18 patients undergoing elective AAA repair. Arterial blood was serially sampled from admission (or at the start of elective operation) to day 13 in the intensive care unit, and the serum concentrations of tumor necrosis factor-iv (TNF-a), interleukin (IL)-1jtf, and IL-6 were determined.

A trauma‐like elevation of plasma cytokines in humans in response to treadmill running

“…Elevated levels of TNFá did occur, but usually much later concomitantly with multiple organ failure, or just before death. Other studies report similar findings which has led to the suggestion that elevated TNFá and IL_1â are connected to bacterial challenges, whereas elevations in IL_6 following trauma are associated with soft tissue damage (Roumen et al 1993;Svoboda et al 1994;Biffl et al 1996;Martin et al 1997). …”

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

“…After major non-cardiac surgery, in particular major abdominal surgery 55 , cancer surgery 56 , and vascular surgery 57 , an early increase in plasma concentrations of both pro-and anti-inflammatory cytokines was also reported. A close relationship between cytokine release and the extension of surgical trauma [58][59][60] , and in particular with the extension of ischaemia and reperfusion 61 , was observed in aortic aneurysm surgery. Recent findings indicate that proinflammatory cytokines affect vascular function and endothelium-derived factors involved in blood pressure regulation.…”

Serum concentrations and renal expressions of IL-1 and TNF-a early after hemorrhage in rats under the effect of glibenclamide

“…Tissue hypoxia that occurs after hemorrhagic shock produces changes in cellular organic metabolism 2 , and induces the release of proinflammatory cytokines, such as interleukins one and six (IL-1 and IL-6) and tumor necrosis α factor (TNF-α), into the plasma. The excessive activation of inflammatory mediators after trauma/hemorrhagic shock leads to multiple organ dysfunction syndromes, a major cause of mortality in patients [3][4][5] . Ischemia/reperfusion process triggers macrophages and activated Küpffer cells release inflammatory cytokines 6 .…”