PATHOGENESIS AND PREDICTION OF CRITICAL COMPLICATIONS OF POLYTRAUMA FROM THE POSITION OF COMMON PATHOLOGICAL PROCESSES
Polytrauma can be determined as a life-threatening multi-trauma, which requires for intensive care. Most patients die within the first 4 hours after polytrauma. In the later period, the main cause of death is systemic inflammation (SI), which should be distinguished from protective manifestations of posttraumatic classic inflammation - the adaptive variant of systemic inflammatory response (SIR). Objective - to describe the pathogenesis of SI as the general pathologic process and its role in development of critical complications in polytrauma. Methods. The analytic (deconstruction) review of literature with use of results and own studies. Results. The core of SI pathogenesis as the general pathologic process is microcirculatory disorders. Clinical manifestation of SI is refractory shock, ongoing signs of multiple organ dysfunction, disseminated intravascular clotting (DIC), secondary acute respiratory distress syndrome, but not the criteria of SIR which are low specific to development of critical complications. For verification and monitoring of SI, it is appropriately to fix some qualitative levels of SIR with several molecular criteria of SIR, for example, blood plasma cytokines. Moreover, it is necessary to systematize some range and other signs of SI, including DIC, intravascular activation of phagocytes and complement system, intensity of systemic tissue injury and organ dysfunction, distress response of neuroendocrine system, signs of tissue perfusion disorders. Conclusion. Pathogenesis of polytrauma combines various types of inflammation: classic one, which determines adaptation of the body to an injury; systemic inflammation, which is characterized by life-threatening microcirculatory disorders and chronic inflammation of low intensity (parainflammation) which is the basis of many chronic disease of older age and is considered as the risk factor of critical complications of polytrauma.