Persistent inflammation and immunosuppression

Innate immune responses to trauma

“…In the long term, beyond 14 days after trauma, patients receiving modern management in the intensive care unit might survive the consequences of trauma and not develop late MODS. However, such patients often show signs of persistent inflammation-immunosuppressive catabolism syndrome (PICS), which, in addition to being associated with ongoing protein catabolism, is associated with innate and adaptive immunosuppressive features 41 . These consist mainly of reduced generation of cytokines, loss of monocyte-macrophage function, a persistently increased number of myeloid-derived suppressor cells (MDSCs) and a reduction in the number and function of effector T cells.…”

“…These consist mainly of reduced generation of cytokines, loss of monocyte-macrophage function, a persistently increased number of myeloid-derived suppressor cells (MDSCs) and a reduction in the number and function of effector T cells. The PICS-based immunological-metabolic suppression correlates with poor wound healing, infections, a long decline and a high mortality rate 41 .…”

“…Notably, deaths after that early phase are caused to a lesser extent directly by the trauma itself and instead are caused by infectious and septic complications 180,181 , which develop in particular during conditions of prolonged immunosuppression or, later, in the context of PICS 41 ; therefore, not only preventing damaging immunological reactions but also reinforcing innate immunity might improve the outcome by overcoming the period of severe immunosuppression. In the context of trauma, various interventions to inhibit or augment the immune response, such as antibody to L-selectin, hydrocortisone, prostaglandin E1, aprotinin, immunoglobulins, interferon-γ, immunonutrition, probiotics, etc., have been applied, analyzed in detail and reviewed elsewhere 1,182 .…”

Persistent inflammation, immunosuppression, and catabolism syndrome after severe blunt trauma

“…From these observations, we recently proposed a new model of chronic critical illness (CCI) (Figure 1) where the phenotype of ‘late MOF’ is replaced with a new syndrome termed persistent inflammation, immunosuppression and catabolism syndrome (PICS) (9). These patients generally proceed along a ‘complicated’ course requiring transfer to long-term acute care facilities (LTACs), where they ultimately experience indolent deaths.…”

Practical Understanding of Hemostasis and Approach to the Bleeding Patient in the Operating Room

“…Excessive and prolonged pro-inflammatory response following trauma has been associated with multi-organ failure and death. [14, 15]…”