Role of gaseous transmitters in the pathogenesis of organ dysfunction in multiple trauma

N.V. Matolinets


The review of modern data about the role of gaseous transmitters in multiple trauma patients with regard to the theory of stress and pathogenesis of major complications is presented. It is known that the system of nitric oxide (NO) production is the stress-limiting system. Mechanisms responsible for the development of stress-induced reactions include both the increase of sympathetic nervous system activity, glucocorticoid overload that correlates with severity of clinical symptoms, and the change of endothelial function, including the reduction of NO bioavailability. Oxidative stress is an important determinant of endothelial dysfunction development. The reactive oxygen species also change hydrogen sulfide-related mechanisms, which influence the signaling pathways of endothelium. The hydrogen sulfide (H2S) has a unique mechanism of action on vessels, protects neurons from oxidative stress. NО also acts as an antioxidant that inhibits free-radical reactions in physiological conditions. There are reports about cross reactions between H2S and NO that form a nitrosothiol complex, which acts as a new way of signal transmission and is an important factor of forming protective and pathological reactions to the action of acute stress factors. Currently, an active search is being conducted for effective prognosticators of multiple trauma outcomes and means to correct secondary organ damage (cerebrum, lungs, kidneys) that can result in multiple organ failure. The dependence of NO production on trauma severity, as well as its multimodal impact on complications pathogenesis in relation to the stress reaction allows considering it as prognostic marker of multiple trauma outcome. The use of active gaseous transmitter precursors (L-arginine as NO donator, sodium hydrosulfide as H2S donator) allows elaborating new treatment modalities for critically ill patients with multiple injuries, although the mechanisms of their action and interactions need further research.


multiple trauma; multiple organ failure; gaseous transmitters; nitric oxide; hydrogen sulfide; review


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