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Inflammatory response to trauma: implications for coagulation and resuscitation

Pierce, Albert; Pittet, Jean-François

Current Opinion in Anesthesiology: April 2014 - Volume 27 - Issue 2 - p 246–252
doi: 10.1097/ACO.0000000000000047
TRAUMA AND TRANSFUSION: Edited by Richard P. Dutton

Purpose of review Recent studies have changed our understanding of the timing and interactions of the inflammatory processes and coagulation cascade following severe trauma. This review highlights this information and correlates its impact on the current clinical approach for fluid resuscitation and treatment of coagulopathy for trauma patients.

Recent findings Severe trauma is associated with a failure of multiple biologic emergency response systems that includes imbalanced inflammatory response, acute coagulopathy of trauma, and endovascular glycocalyx degradation with microcirculatory compromise. These abnormalities are all interlinked and related. Recent observations show that after severe trauma: proinflammatory and anti-inflammatory responses are concomitant, not sequential and resolution of the inflammatory response is an active process, not a passive one. Understanding these interrelated processes is considered extremely important for the development of future therapies for severe trauma in humans.

Summary Traumatic injuries continue to be a significant cause of mortality worldwide. Recent advances in understanding the mechanisms of end-organ failure, and modulation of the inflammatory response has important clinical implications regarding fluid resuscitation and treatment of coagulopathy.

Department of Anesthesiology, University of Alabama at Birmingham, Birmingham Alabama, USA

Correspondence to Jean-François Pittet, MD, Department of Anesthesiology, University of Alabama at Birmingham, 619 South 19th Street, JT926, Birmingham AL 35249, USA. Tel: +1 205 996 4755; fax: +1 205 996 4765; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.