ReviewFrontiers in physiology2022
Why are bleeding trauma patients still dying? Towards a systems hypothesis of trauma.
Review in Frontiers in physiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed.
- Fluid bolus increases plasma hyaluronan concentration compared to follow-up strategy without a bolus in oliguric intensive care unit patients.Scientific reports · 2024Trial
- Shock Induced Endotheliopathy and High Trauma Mortality-Fight-or-Flight Response Revisited.International journal of molecular sciences · 2026Review
- Traumatic Brain Injury in the Omics Era: Plasma and Extracellular Vesicle Proteomic Signatures in Polytrauma.Medical sciences (Basel, Switzerland) · 2026Article
- A totally laparoscopic strategy combining microwave ablation and autologous blood transfusion for patients with initial WSES grade IV traumatic splenic rupture in selected transient responders: a proof-of-concept study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Article
- Exploring Molecular Mechanism of Thymoquinone via cMet and PDGFR for Accelerated Hemostasis: An Approach Through In Silico, In Vitro, and In Vivo Studies.Chemistry & biodiversity · 2026Article
- Applications of Hydrogels in Emergency Therapy.Gels (Basel, Switzerland) · 2025Review
- Targeting Inflammation After Hemorrhagic Shock as a Molecular and Experimental Journey to Improve Outcomes: A Review.Cureus · 2025Review
- Navigating Hemorrhagic Shock: Biomarkers, Therapies, and Challenges in Clinical Care.Biomedicines · 2024Review
- Pathophysiology of Severe Burn Injuries: New Therapeutic Opportunities From a Systems Perspective.Journal of burn care & research : official publication of the American Burn Association · 2024Review
- Ventriculo-arterial (VA) coupling and fQRS as new selection criteria for primary prevention ICD placement.Intensive care medicine experimental · 2024Article
- Revolution in sepsis: a symptoms-based to a systems-based approach?Journal of biomedical science · 2024Review
- Transforming research to improve therapies for trauma in the twenty-first century: an alternative perspective.Critical care (London, England) · 2024Article
- Impact of Immunopathy and Coagulopathy on Multi-Organ Failure and Mortality in a Lethal Porcine Model of Controlled and Uncontrolled Hemorrhage.International journal of molecular sciences · 2024Article
- The Factors Associated With Decreasing Hemoglobin Levels and Platelet Counts After Trauma.Cureus · 2024Article
- Lung Protection After Severe Thermal Burns With Adenosine, Lidocaine, and Magnesium (ALM) Resuscitation and Importance of Shams in a Rat Model.Journal of burn care & research : official publication of the American Burn Association · 2024Article
- Navigating the 'Triangle of Death': A Multidisciplinary Approach in Severe Multi-Trauma Management.Clinical medicine insights. Case reports · 2024Article
- Influence of Lavender Essential Oil on the Physical and Antibacterial Properties of Chitosan Sponge for Hemostatic Applications.International journal of molecular sciences · 2023Article
- Incidence, demographics and outcomes of patients with penetrating injury: a Japanese nationwide 10-year retrospective study.BMJ open · 2023Article
- SHock-INduced Endotheliopathy (SHINE): A mechanistic justification for viscoelastography-guided resuscitation of traumatic and non-traumatic shock.Frontiers in physiology · 2023Review
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Over the years, many explanations have been put forward to explain early and late deaths following hemorrhagic trauma. Most include single-event, sequential contributions from sympathetic hyperactivity, endotheliopathy, trauma-induced coagulopathy (TIC), hyperinflammation, immune dysfunction, ATP deficit and multiple organ failure (MOF). We view early and late deaths as a systems failure, not as a series of manifestations that occur over time. The traditional approach appears to be a by-product of last century's highly reductionist, single-nodal thinking, which also extends to patient management, drug treatment and drug design. Current practices appear to focus more on alleviating symptoms rather than addressing the underlying problem. In this review, we discuss the importance of the system, and focus on the brain's "privilege" status to control secondary injury processes. Loss of status from blood brain barrier damage may be responsible for poor outcomes. We present a unified Systems Hypothesis Of Trauma (SHOT) which involves: 1) CNS-cardiovascular coupling, 2) Endothelial-glycocalyx health, and 3) Mitochondrial integrity. If central control of cardiovascular coupling is maintained, we hypothesize that the endothelium will be protected, mitochondrial energetics will be maintained, and immune dysregulation, inflammation, TIC and MOF will be minimized. Another overlooked contributor to early and late deaths following hemorrhagic trauma is from the trauma of emergent surgery itself. This adds further stress to central control of secondary injury processes. New point-of-care drug therapies are required to switch the body's genomic and proteomic programs from an injury phenotype to a survival phenotype. Currently, no drug therapy exists that targets the whole system following major trauma.
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