[Post-traumatic/postoperative immune deficiency syndrome].

Severe trauma, major surgery and burns (TSB) are often followed by infections, adult respiratory distress syndrome and multi-organ failure, complications which are thought to be the consequence of the post-TSB immunodeficiency syndrome. The most important data and hypotheses in this regard are summarized. After a TSB event large amounts of tissue debris, endotoxins and microorganisms have to be eliminated. Further important factors in TSB are stress reactions, malnutrition, loss and replacement of fluids and therapeutic measures. The elimination of unwanted elements is partly carried out by non-specific mechanisms such as opsonisation, chemotaxis and phagocytosis by granulocytes and cells of the macrophage/monocyte lineage, while specific reactions of humoral and cellular immunity also play a role. Severe TSB is thought to be associated with growing exhaustion of the unspecific defense system, leading to deficient specific immune reactions. Routinely measurable parameters only partly reflect the complex events after TSB: there is a decline in serum levels of fibronectin, immunoglobulins and some components of complement, in chemotaxis, phagocytosis and intracellular killing, and in circulating T3 and T4 lymphocytes as well as some lymphocyte functions. Some of these measurable parameters of defense mechanisms are statistically predictive for the occurrence of infections and other sequelae of TSB. Specific prophylactic and therapeutic measures can only be taken, if at least some of the complex events after TSB are better understood.