Influence of surgical intervention in the immune response of severely injured XXXX .

@entity310 @entity1 @entity688 @entity130
OBJECTIVE: Primary events such as severe injury and elective surgery cause a deterioration of the immune response measurable by reduction of expression of HLA-DR on monocytes or ex vivo LPS-induced @entity310 production. The further influence of secondary surgery after severe injury on the immune response remains unresolved. DESIGN: Prospective observation study. SETTING: Surgical intensive care unit of an university hospital. @entity1 : Sixteen severely injured @entity1 with an ISS >25 points. MEASUREMENTS AND RESULTS: On day 1 after @entity130 and immediately before secondary surgery, mean fluorescence intensity (MFI) of HLA-DR expression on monocytes and @entity310 ex vivo synthesis was significantly reduced compared to healthy donors. Overall, surgical intervention during the second week after @entity130 caused no further reduction of HLA-DR expression on monocytes and of the ex vivo @entity310 -synthesis. However, major surgery such as intramedullary nailing or pelvic osteosynthesis caused reduction of the HLA-DR expression and @entity310 -synthesis, whereas, minor surgical interventions such as osteosynthesis on peripheral joints exhibited no significant effects on the immune response. Surgical intervention performed to clear septic foci normalised immune response by elevating HLA-DR expression on monocytes and ex vivo @entity310 synthesis. @entity130 caused elevated serum @entity688 levels, whereas secondary surgery did not induce a further increase in serum @entity688 levels. CONCLUSION: This study shows that initial @entity130 as well as major secondary surgery causes a suppression of immune functions, whereas minor secondary surgery does not cause significant immune disturbance.
