Clinical Factors Influencing Host Defense Integrity

Abstract

The stress response (neuroendocrine, lymphokine-cytokine) is thought to be inevitable following surgery or trauma, and little consideration is given by clinicians to its control, limitation or elimination. Can we, by clinical behaviour, reduce the cost to the patient of an injury or an operation? In 1987, at the First Conference in Munich, the data were limited and somewhat indirect; however, today there is increasing evidence that blunting these responses decreases morbidity. The biology is not clear at present, but it is quite apparent that afferent blockade, postoperative pain control, surgical technique, transfusions, nutrition, speed of resuscitation, the products of modern biotechnology and surgical approaches can all dramatically influence the cost of surgery and trauma to a patient. The patient-based factors are acute and chronic state of health, fitness, medications, magnitude of injury, etc. The surgeon controls are pre- as well as intra-operative decision making, anaesthetic techniques, and a host of ancillary therapeutic manoeuvres. The differences in clinical evolution between laparoscopic and open cholecystectomy suffice to indicate that clinical approaches can influence the stress response. The relative ease of liver transplantation and modern results in burn care all indicate that clinical care profoundly influences biology and patients’ clinical evolution.