Plasma catecholamines in severely injured patients: A prospective study on 45 patients with multiple injuries

Abstract

Plasma catecholamine levels were studied in 45 severely injured patients for 8 days after the trauma. Sixteen of the patients were classified as critically injured and 29 as seriously injured. The total plasma catecholamine values of the whole group immediately after the injury were almost twice as high as the eighth day reference values and remained significantly higher than these values for 6 hours after the trauma. On admission both the plasma adrenaline and noradrenaline levels were elevated. The plasma adrenaline levels on admission correlated with the blood volume replacement which was required within the first 6 hours. The plasma noradrenaline levels in the critically injured group were significantly higher throughout the observation period than in the seriously injured group. A corresponding difference was observed in the plasma adrenaline concentrations only during the first 12 hours. The results showed that strong stimulation of the sympathetic nervous system occurs in severely injured patients. Factors stimulating the sympathetic nervous system apparently included hypovolaemia, tissue hypoxia, acidosis and the pain produced by the trauma and therapeutic measures.

Variability of insulin sensitivity during the first 4 days of critical illness: implications for tight glycemic control

“…The counter-regulatory hormones: cortisol, glucagon, the catecholamines, as well as growth hormone are significantly elevated almost immediately after critical-insult, but decline rapidly over the first 12–48 hours [21-24]. These hormones are known to cause increased hepatic glucose production, inhibition of insulin release, and peripheral insulin resistance [22], all of which cause a decrease in the model-based SI metric used in this study.…”

Elderly trauma patients have high circulating noradrenaline levels but attenuated release of adrenaline, platelets, and leukocytes in response to increasing injury severity

“…The present study included 80 trauma patients (median age 46 yrs [IQR 33-64], 68% males) with ISS in the entire range (median 17 [IQR [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]; ISS >26 n = 23, 15-26 n = 26, and <15 n = 30); 91% suffering from blunt trauma and 31% with severe traumatic brain injury (sTBI, Abbreviated Injury Score head >3). Most patients (96%) were referred by mobile emergency care units staffed with anesthetists (28% by helicopter) and blood samples were drawn a median of 68 min (IQR 48-88) after the injury.…”

“…Importantly, we also found an association between high circulating adrenaline levels and increased activated partial thromboplastin time (APTT) (6), a marker of acute coagulopathy of trauma and shock (9), with the highest levels of adrenaline in nonsurviving trauma patients (6). Given the importance of the sympathoadrenal, immune, and hemostatic systems, including the endothelium for outcome in trauma patients (6,7,(10)(11)(12)(13)(14)(15), it is of interest that these systems are significantly affected by age (16)(17)(18)(19)(20)(21)(22)(23).…”

Isoform‐specific regulation of transforming growth factor‐β mRNA expression in macrophages in response to adrenoceptor stimulation

“…In the present study, Ad markedly increased TGF‐β3 mRNA expression in macrophages. Traumatic injury reportedly induces massive release of catecholamines from the sympathetic nervous system . Taken together, it seems that after their release from the sympathetic nervous system following traumatic injury, catecholamines may influence wound healing by upregulating TGF‐β3 expression in macrophages.…”