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Table 1 Overview of insult conditions in severe trauma vs. severe COVID-19 and suggested therapeutic targets

From: Lessons learned from the mechanisms of posttraumatic inflammation extrapolated to the inflammatory response in COVID-19: a review

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