Table 1 Overview of insult conditions in severe trauma vs. severe COVID-19 and suggested therapeutic targets
Insult condition | Severe trauma | Severe COVID-19 | Targets for therapy |
|---|---|---|---|
1st hit Evokes SIRS/CARS-response | Initial trauma | Initial infection | Immunomodulation: Optimizes direct pathway Optimizes indirect pathway Avoid intensifying the immune response with therapeutic concepts aimed to ‘boost’ the immune response |
2nd hits Intensifies SIRS/CARS-response | Surgery/ Invasive procedures | Invasive procedures | Minimizing interventions Postponing elective surgery |
Barotrauma (mechanical ventilation) | Barotrauma (mechanical ventilation) | Lung protective ventilation:  - Avoiding high-PEEP  - Lower tidal volume  - Lower plateau pressure  - Frequent prone positioning | |
Thrombo-embolic events | Thrombo-embolic events | Adequate thrombosis prophylaxis:  - Medication  - Intermittent pneumatic compression  - Automatic lateral rotation therapy  - Early mobilization | |
Transfusion of blood products | Transfusion of blood products | Minimizing transfusion Consider Tranexamic acid | |
Secondary bacterial infection | Secondary bacterial infection |  - Calculated anti-infective therapies  - Frequent clinical examination to identify concurrent infection  - Frequent determination of serum inflammatory markers  - Routine renewal of urine and central catheters |