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Review
. 2020 Jul 9:14:28.
doi: 10.1186/s13037-020-00253-7. eCollection 2020.

Lessons learned from the mechanisms of posttraumatic inflammation extrapolated to the inflammatory response in COVID-19: a review

Michel P J Teuben  1   2   3 , Roman Pfeifer  1   2 , Henrik Teuber  1   4 , Leonard L De Boer  5   6 , Sascha Halvachizadeh  1   2 , Alba Shehu  7 , Hans-Christoph Pape  1   2
Affiliations
Review

Lessons learned from the mechanisms of posttraumatic inflammation extrapolated to the inflammatory response in COVID-19: a review

Michel P J Teuben et al. Patient Saf Surg. .

Abstract

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.

Keywords: ARDS; Covid-19; Inflammation; SARS-CoV-2; Severe trauma, critical care.

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Conflict of interest statement

Competing interestsWe (We represents all listed authors (MT, RP, HT, LB, SH, AS, HCP) wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Figures

Fig. 1
Fig. 1
Sequential thresholds in virus-evoked inflammation. A hypothetical multifactorial model of disease progression in COVID-19 is presented. Two specific pathways have been described, and an interplay is likely to occur. At all phases restoration of homeostasis is possible and will lead to recovery. The development of differentiated treatment concepts may benefit from this model, guide tailored interventions at different stages of disease progression. Abbreviations: ALI, acute lung injury; ARDS, acute respiratory distress syndrome; PAMPs, pathogen associated molecular patterns; DAMPs, damage associated molecular patterns
Fig. 2
Fig. 2
Proposed model of consecutive insult conditions and systemic inflammatory disease progression in COVID-19, based on established trauma modelling. Established concepts in the field of severe trauma and related inflammatory complications have been applied to COVID-19 disease progression. Systemic inflammation may contribute to the restoration of homeostasis and should be considered a physiological process. However, altered inflammatory response may lead to hyperinflammation or a pathological hypo-inflammatory immune response. See text for details and explanations. Abbreviations: SIRS, systemic inflammatory response syndrome; CARS, compensatory anti-inflammatory response syndrome
See this image and copyright information in PMC

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