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

Michel P J Teuben; Roman Pfeifer; Henrik Teuber; Leonard L De Boer; Sascha Halvachizadeh; Alba Shehu; Hans-Christoph Pape

doi:10.1186/s13037-020-00253-7

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

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

Authors

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 Shehu⁷, Hans-Christoph Pape^{1

2}

Affiliations

¹ Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland.
² Harald Tscherne Laboratory for Orthopedic Research, Zurich, Switzerland.
³ Department of Spine- Neuro- and Special orthopedic Surgery, Rhein-Maas Klinikum Würselen, Aachen, Germany.
⁴ Department of Surgery, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
⁵ Imperial College London, London, UK.
⁶ The Francis Crick Institute, London, UK.
⁷ Department of Trauma and Orthopedic Surgery, Marienhospital, Aachen, Germany.

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.

Publication types

Review