[Inflammation and immunoparalysis. What are the differential criteria?]

Multiple organ failure (MOF) may occur early or late after trauma. Besides direct physical injury of organs, compromise of the microcirculation by inflammation plays an important role in the pathogenesis of MOF. Inflammation also induces counterregulatory responses which may end up in immunoparalysis. As a result, infection and sepsis with additional inflammatory damage to the microcirculation ensue thereby contributing to the late development of MOF. In addition to this biphasic model of posttraumatic MOF, there is evidence that inflammation and immunoparalysis do not only occur in sequence to each other but in parallel early after surgical procedures. The aim of the present brief review is to summarize the posttraumatic mechanisms of inflammation and immunoparalysis and to discuss how to differentiate between both pathophysiologic states.