Scribd Logo
Upload

Welcome to Scribd!

  • 5.1.1.2 Physiologic Response To Injury

    Uploaded by

    golfntwsx
    16 views23 pages
    The document summarizes the physiologic response to injury, which involves the central nervous system, hormonal, metabolic, and immune/inflammatory responses. An excessive or inadequate response can lead to multiple organ failure in up to 30% of severe trauma patients. The inflammatory response and microcirculatory dysfunction are hypothesized to play a role in the development of multiple organ dysfunction syndrome. Early resuscitation and treatment of underlying causes, as well as organ support are important in the management of multiple organ dysfunction syndrome.

    Original Description:

    Original Title

    5.1.1.2 Physiologic response to injury-

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document summarizes the physiologic response to injury, which involves the central nervous system, hormonal, metabolic, and immune/inflammatory responses. An excessive or inadequate response can lead to multiple organ failure in up to 30% of severe trauma patients. The inflammatory response and microcirculatory dysfunction are hypothesized to play a role in the development of multiple organ dysfunction syndrome. Early resuscitation and treatment of underlying causes, as well as organ support are important in the management of multiple organ dysfunction syndrome.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    16 views23 pages

    5.1.1.2 Physiologic Response To Injury

    Uploaded by

    golfntwsx
    The document summarizes the physiologic response to injury, which involves the central nervous system, hormonal, metabolic, and immune/inflammatory responses. An excessive or inadequate response can lead to multiple organ failure in up to 30% of severe trauma patients. The inflammatory response and microcirculatory dysfunction are hypothesized to play a role in the development of multiple organ dysfunction syndrome. Early resuscitation and treatment of underlying causes, as well as organ support are important in the management of multiple organ dysfunction syndrome.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 23

    Physiologic response to injury

    ศุภฤกษ์ ปรี ชายุทธ


    Response to injury
    • CNS
    • Hormonal
    • Metabolic
    • Immune/Inflammation

    • TOO Much/Inadequate response → MOF (up to 30% after severe


    trauma)
    CNS response
    • Stimuli
    • Pain
    • Change in blood pressure (Baroreceptor)
    • Change in CO2, O2, pH (Chemoreceptor)
    • Inflammatory Cytokines

    • Response
    • Sympathetic ANS (catecholamines)
    • Parasympathetic ANS (anti-inflammation)
    Inflammatory reflex
    Hormonal response
    Adrenal shock
    • Lack of aldosterone
    • ↓ preload
    • Lack of cortisol
    • ↑ Inflammation
    • ↓ Vasoconstriction (afterload)
    Metabolic response
    Resting energy expenditure (REE) during stress conditions
    Enteral Nutrition (EN): preferred route
    • Preserves gut integrity
    • Decreases bacterial translocation
    • Preserves function of gut/liver (trophic effect)
    • Reduces costs
    • Has fewer complications
    Normal Gut

    Mucosal disruption after


    prolonged NPO
    Contraindications of EN
    • Hemodynamic instability →EN can induce gut ischemia
    • Ileus or gut obstruction
    • High output enterocutaneous fistula (in an early phase)
    • Active GI bleeding
    • Peritonitis
    • Intestinal ischemia
    • Severe acute pancreatitis
    Route of EN
    • Gastric route is preferred.
    • Post pyloric feeding (↓ aspiration)
    • Gastric pathology
    • High residual volume
    Immune response
    Specific immunity mediated by helper T lymphocytes subtype 1 (TH1) and
    subtype 2 (TH2) after injury.
    Multiple organ failure after trauma
    • MOF in trauma patients accounts for 50% of delayed
    deaths, lungs and kidneys are affected first (within 3
    days) .
    • Liver failure usually occurs later (after 3 days).
    Microcirculatory Hypothesis
    • Inflammatory CKs
    • Endothelial cell damage
    • Capillary dysfunction
    • Occlusion
    • Leakage
    Disseminated Intravascular Coagulation (DIC)

    • 30-50% in sepsis
    • Coagulation failure → uncontrolled activation of both coagulation and
    fibrinolysis
    • Clot in microcirculation → MOF
    Microcirculatory Hypothesis
    Edema
    Pump failure Renal failure

    Death Heart Lung Renal Gut Skin


    Brain Muscle

    ARDS • Second hit injury


    Altered • Bacterial
    Mental status translocation
    - Leakage
    - Thrombosis
    (DIC, ↑wbc adherence)
    Cellular/tissue dysoxia
    • In severe sepsis/SIRS
    • Inability to use O2 despite adequate O2 delivery
    • Defect in O2 extraction
    Inflammatory model
    • Interaction of Cytokines, Complement
    and Coagulation system
    • Imbalance between SIRS and CARS
    • Neutrophils
    • Inflammatory mediators
    • ROM
    • Neutrophil extracellular traps
    (NETs) → endothelial injury
    Gut Hypothesis
    - Gut is protected by mucosa and Immune cells (GALT)
    - Shock → Gut Hypoxia → Mucosal leakage
    → ↑ Mucosal permeability → Bacterial translocation → Liver →
    SIRS
    - Gut = “Undrained Abscess”
    One-Hit and Two-Hit Theory
    - One-Hit Theory; → → O
    - Two-Hit Theory;
    - 1st Hit = Less severe insult “Primed Activation” of the
    Inflammation
    - 2nd Hit = the Reactivation insult
    → → O w
    already been activated.)
    Management of MODS
    • 1. Resuscitation
    • 2. Correct the causes!
    • Infection, inflammation
    • Bleeding, injury
    • 3. Support organ failure
    • 4. Metabolic support
    • Nutrition
    • 5. Immunonutrients → no clear benefit

    You might also like