Macrophage — T-Cell Interactions in Surgical Sepsis

Abstract

As surgical and anesthetic management of patients with multiple injuries or those requiring major surgery have improved, the types of problems facing clinicians have changed. A chronicle of this evolution is provided by the various military conflicts in this century. In World Wars I and II, most deaths occurred due to irreversible hemorrhagic shock. In the Korean War, many casualties survived the initial period of shock but developed acute renal failure (ARF) with a mortality of 50% [1]. More rapid transport of injured patients, better management of shock, and the use of dialysis in Vietnam led to a lower incidence of ARF [2]. However, a new complication appeared in the form of adult respiratory distress syndrome (ARDS). Respiratory failure often occurred in patients without thoracic injuries and was associated with a mortality of 50%–60% [3]. Although early aggressive resuscitation of patients in shock and utilization of positive pressure ventilation have decreased the incidence of ARF and ARDS, the mortality for these complications has not changed appreciably in the last ten years [4].