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Sepsis and infection are the major enemies of the intensive care
patient in whom immunological defenses are severely impaired. This
major problem is thefocus of attention in this book, based on the
presentation of the First International Congress on the Immune
Consequences of Trauma, Shock, and Sepsis, which is one of the
first attempts to exchange ideas on the state-of-the-art in this
area of immunology. Both basic and clinical research, including new
centres of attention, are described. The growing role of immunology
in medicine opens new avenues to the under- standing of trauma and
sepsis and will allow the design of novel therapeutic approaches.
Over two decades an abundance of knowledge has been accumulated
focus ing on the understanding of the molecular and cellular
pathomechanisms of stressful conditions like systemic inflammation
and sepsis. We have learned that there is a clear correlation
between the magnitude of the inciting traumatic event and the
degree of inflammatory dysbalance. The immunoinflammatory
disintegration comprises a simultaneous col lapse of the otherwise
very smoothly balanced pro- and antiinflammatory vectors of
cytokine regulation. Most recently, we understood that it is
predominantly the dysregulation of antiinflammatory mediators that
plays a pivotal role for the phenomenon of trauma-induced
depression or paralysis of cell-mediated immune responses. The
substantial intellectual and logistic investments of numerous
investi gators towards understanding the biology of sepsis
inevitably lead us towards a rewarding status in terms of reaching
spheres of clinical relevance. From the evolutionary collection of
a multitude of ex-vivo and in-vivo immuno mechanistic parameters,
some were found to represent most significant bio logical markers
to support the clinician to characterize better the severity of
inflammatory illness and to predict outcome. Chapter one of this
book, authored by G. Grass and E.A.M. Neugebauer, analyses
elegantly our current knowledge on the assessment of the immuno
logical status in terms of risk and prognosis of sepsis.
Inflammation in itself is not to be considered as a disease . . .
and in disease, where it can alter the diseased mode of action, it
likewise leads to a cure; but where it cannot accomplish that
solitary purpose . . . it does mischief - John Hunter, A Treatise
on the Blood, ITfIlammation, and Gunshot Woundr (London, 1794)1 As
we reached the millennium, we recognized the gap between our
scientific knowledge of biologic processes and our more limited
clinical capabilities in the care of patients. Our science is
strong. Molecular biology is powerful, but our therapy to help
patients is weaker and more limited. For this reason, this book
focuses on the problems of multiple organ failure (MOF), multiple
organ dysfunction syndrome (MODS), and systemic inflammatory
response syndrome is, patients who have severe injuries; require
major, (SIRS) in high-risk patients, that overwhelming operations;
or have serious illnesses requiring intensive care; patients who
have diseases elsewhere, in other organs or systems, that limit
their capabilities to survive a new insult; and patients who are
elderly or at high risk for sepsis or other complications. These
are the patients who need our help. They need the advances in
science, in molecular biology, immunology, pathophysiology,
biochemistry, genetics, high technology, and other areas of maximum
support at the bedside. These advances could potentially have the
greatest impact on improving patient care.
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