[Pharmacologic prevention of SIRS (systemic inflammatory response syndrome) in severe thoracic injuries]

Frequency and severity of the blunt chest injuries are increasing. Rather high letality is caused by the injury and following systemic inflammatory response.

The aim of the study is to verify the efficacy of pharmacological blockade of the systemic inflammatory response syndrome (SIRS) in serious blunt chest injuries. The aim is also to find out if the administration of indomethacin as a cyclooxygenase inhibitor could prevent multiorgan dysfunction (MODS) and multiorgan failure (MOF).

Patients were divided into 4 groups according to trauma severity (Injury Severity Score). The group I. contains patients with ISS up to 17. There is no premise of the SIRS development. In the group II. there were patients with ISS 18-30, which means polytrauma group due to new definition. In the group III. there were patients with ISS 31-40 (severe trauma). Group IV. contains critically injured patients (ISS 41 and higher). Some patients involved in our study were given indomethacin (as cyclooxygenase inhibitor in arachidonic acid cycle) together with standard therapy.

65 patients were included into study in last 14 months, 22 patients were given indomethacin. The group with indomethacin administration has later increase of inflammatory markers in groups III. and IV. This increase also takes less time in groups II. and III. Shorter time of mechanical ventilation support in group III. in patients with indomethacin was significant. SIRS is present in time of admission approximately in 44%. All patients have low antioxidants level. 5 patients died in our group, letality was 7.7%. All the died patients came from the subgroup without indomethacin, however only one death caused by MOF.

From the results of the first 14 months of the study we can conclude that certain number of patients with serious blunt thoracic trauma could benefit from indomethacin administration.