Teuben Michel P J, Pfeifer Roman, Teuber Henrik, De Boer Leonard L, Halvachizadeh Sascha, Shehu Alba, Pape Hans-Christoph
Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland.
Harald Tscherne Laboratory for Orthopedic Research, Zurich, Switzerland.
Patient Saf Surg. 2020 Jul 9;14:28. doi: 10.1186/s13037-020-00253-7. eCollection 2020.
Up to 20% of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients develop severe inflammatory complications with diffuse pulmonary inflammation, reflecting acute respiratory distress syndrome (ARDS). A similar clinical profile occurs in severe trauma cases. This review compares pathophysiological and therapeutic principles of severely injured trauma patients and severe coronavirus disease 2019 (COVID-19). The development of sequential organ failure in trauma parallels deterioration seen in severe COVID-19. Based on established pathophysiological models in the field of trauma, two complementary pathways of disease progression into severe COVID-19 have been identified. Furthermore, the transition from local contained disease into systemic and remote inflammation has been addressed. More specifically, the traumatology concept of sequential insults ('hits') resulting in immune dysregulation, is applied to COVID-19 disease progression modelling. Finally, similarities in post-insult humoral and cellular immune responses to severe trauma and severe COVID-19 are described. To minimize additional 'hits' to COVID-19 patients, we suggest postponing all elective surgery in endemic areas. Based on traumatology experience, we propose that immunoprotective protocols including lung protective ventilation, optimal thrombosis prophylaxis, secondary infection prevention and calculated antibiotic therapy are likely also beneficial in the treatment of SARS-CoV-2 infections. Finally, rising SARS-CoV-2 infection and mortality rates mandate exploration of out-of-the box treatment concepts, including experimental therapies designed for trauma care.
高达20%的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）患者会出现伴有弥漫性肺部炎症的严重炎症并发症，这是急性呼吸窘迫综合征（ARDS）的表现。严重创伤病例也会出现类似的临床特征。本综述比较了严重创伤患者和重症冠状病毒病2019（COVID-19）患者的病理生理和治疗原则。创伤患者序贯器官衰竭的发展与重症COVID-19患者的病情恶化相似。基于创伤领域已确立的病理生理模型，已确定了疾病进展为重症COVID-19的两条互补途径。此外，还探讨了从局部受限疾病向全身和远处炎症的转变。更具体地说，导致免疫失调的序贯损伤（“打击”）的创伤学概念被应用于COVID-19疾病进展建模。最后，描述了严重创伤和重症COVID-19患者受伤后体液和细胞免疫反应的相似之处。为尽量减少对COVID-19患者的额外“打击”，我们建议在流行地区推迟所有择期手术。基于创伤学经验，我们提出包括肺保护性通气、最佳血栓预防、继发性感染预防和精准抗生素治疗在内的免疫保护方案可能对SARS-CoV-2感染的治疗也有益。最后，不断上升的SARS-CoV-2感染率和死亡率促使人们探索创新的治疗理念，包括为创伤护理设计的实验性疗法。
