Review Question - QID 8237

In response to trauma, the body demonstrates a systemic inflammatory response that varies in intensity according to the severity of the injuries sustained. Increased production of proinflammatory cytokines serves to activate the host immune system. The activation of systemic inflammatory response may lead to remote end organ damage with neutrophil demargination and disruption of the vascular endothelium. Disturbances in microcirculation exacerbate local tissue hypoxia, and parenchymal necrosis may ensue. Furthermore, the systemic inflammatory response serves as the basis for the development of adult respiratory response distress syndrome (ARDS) and multiple organ failure following trauma. Several serologic inflammatory markers have been investigated for their potential usefulness in measuring and monitoring the inflammatory response to a major trauma. These markers include IL-1, IL-6, IL-8,-IL-10, and C-reactive protein and tumor necrosis factor-alpha. For many of these markers, serum concentration is noted to increase following severe trauma, but the extent and duration of elevation have been too variable to allow for clinical application. IL-6 has been shown to be a reliable measure of systemic inflammatory response, correlating with injury severity and outcome. It has been recommended that measurement of IL-6 concentration be traced to evaluate the severity of the inflammatory response. In this way, it may be possible to clarify the risks associated with secondary procedures such as fracture fixation and to determine when these procedures should be performed.