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While appropriately regulated inflammation supports host defense and tissue repair, dysregulated and time\u2010dependent inflammatory trajectories contribute to postoperative and post\u2010traumatic complications, organ dysfunction, prolonged disability, and mortality. Translation of mechanistic insight into effective bedside strategies has been limited by marked inter\u2010individual heterogeneity, rapid phase shifts in the inflammatory response, and the absence of operational workflows that measure inflammation with sufficient biological and temporal resolution to guide patient\u2010specific decisions. This perspective introduces \u2018inflammatory stewardship\u2019 as a precision\u2010medicine paradigm for proactive management of acute inflammation in perioperative and critical care settings. Inflammatory stewardship integrates two core components: inflammatory staging and biomarker\u2010guided immunomodulation. Inflammatory staging uses serial, multidimensional monitoring to characterize trajectories and to determine whether a patient's current inflammatory status lies within an individualized target range. Monitoring may combine routinely available clinical parameters with more specific immune phenotyping, functional assays, and molecular signatures, provided that assays are standardized, clinically interpretable, and available within actionable turnaround times. Biomarker\u2010guided immunomodulation then links off\u2010target trajectories to patient\u2010specific escalation or de\u2010escalation strategies, supported by predefined safety criteria and interdisciplinary governance. This perspective outlines key implementation requirements and a research agenda to establish reference trajectories, validate actionable endotypes, and embed biomarkers into adaptive interventional study designs. Inflammatory stewardship offers a testable roadmap to operationalize personalized inflammation management after surgery and trauma, aiming to enable earlier detection of maladaptive trajectories and more effective, patient\u2010tailored immunomodulatory care in intensive care.<\/jats:p>","DOI":"10.1096\/fj.202600607r","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T10:52:57Z","timestamp":1782298377000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inflammatory Stewardship\u2014A Perspective for Active Management of Acute Inflammation"],"prefix":"10.1096","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1729-7238","authenticated-orcid":false,"given":"Lennart Finn","family":"Herrlich","sequence":"first","affiliation":[{"name":"Institute of Transfusion Medicine and Immunogenetics Ulm German Red Cross Blood Transfusion Service Baden\u2010W\u00fcrttemberg\u2010Hessen and University Hospital Ulm  Ulm Germany"},{"name":"Institute of Transfusion Medicine University Hospital Ulm  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubert","family":"Schrezenmeier","sequence":"additional","affiliation":[{"name":"Institute of Transfusion Medicine and Immunogenetics Ulm German Red Cross Blood Transfusion Service Baden\u2010W\u00fcrttemberg\u2010Hessen and University Hospital Ulm  Ulm Germany"},{"name":"Institute of Transfusion Medicine University Hospital Ulm  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0834-038X","authenticated-orcid":false,"given":"David Alexander Christian","family":"Messerer","sequence":"additional","affiliation":[{"name":"Institute of Transfusion Medicine and Immunogenetics Ulm German Red Cross Blood Transfusion Service Baden\u2010W\u00fcrttemberg\u2010Hessen and University Hospital Ulm  Ulm Germany"},{"name":"Institute of Transfusion Medicine University Hospital Ulm  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/S0140-6736(18)33139-8","article-title":"Global Burden of Postoperative Death","volume":"393","author":"Nepogodiev D.","year":"2019","journal-title":"Lancet"},{"key":"e_1_2_12_3_1","volume-title":"Report on Injuries and Violence","author":"WHO","year":"2024"},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1002\/bjs.11148","article-title":"Age of Patients Undergoing Surgery","volume":"106","author":"Fowler A. 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