Immune Response In The Critically Ill
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Immune Response In The Critically Ill
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Author : John C. Marshall
language : en
Publisher: Springer Science & Business Media
Release Date : 2002-01-21
Immune Response In The Critically Ill written by John C. Marshall and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2002-01-21 with Medical categories.
This book brings together basic scientists or clinicians from a variety of different backgrounds - immunology, infectious diseases or critical care - who share a common interest in understanding the changes that occur in immune responses in sepsis. It provides an up-to-date and unrivalled synthesis of current research in this rapidly developing field.
Management Of Dysregulated Immune Response In The Critically Ill
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Author : Zsolt Molnar
language : en
Publisher: Springer Nature
Release Date : 2023-03-11
Management Of Dysregulated Immune Response In The Critically Ill written by Zsolt Molnar and has been published by Springer Nature this book supported file pdf, txt, epub, kindle and other format this book has been release on 2023-03-11 with Medical categories.
This book, part of the European Society of Intensive Care Medicine (ESICM) textbook series, deals with dysregulated host response a relatively new term introduced by the Sepsis-3 definitions in 2016. In contrast to systemic inflammatory response syndrome (SIRS) that has been used for nearly 30 years, this is a fundamentally new concept, which requires some sort of a paradigm shift in the way of thinking of critical care physicians. This change obviously requires time and after 5 years, time is ripe to summarize the knowledge in the form of a comprehensive book. The book is split in 4 sections. In the first one, the host immune response is explained in 11 chapters, followed by the next part, summarizing the possible tools for assessment at the bedside. The third and the fourth parts focus on the effects of dysregulated immune response on vital organ function and on the possible ways of immunomodulation. Written by internationally acclaimed experts of the field, the book is of value for all those intensivists and allied professionals working in ICUs.
Immunology In Intensive Care Medicine 2007
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Author : Marcus J. Schultz
language : en
Publisher:
Release Date : 2007-01-01
Immunology In Intensive Care Medicine 2007 written by Marcus J. Schultz and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007-01-01 with Critical care medicine categories.
The critical care community is challenged on a day to day basis by the increasing complexity of managing patients who have sepsis, shock, severe trauma or major operations. Numerous reviews focus on the basic science of immunity in abovementioned states, and various reviews concentrate on the clinical management of patients with these critical injuries that lead to altered immunity. The purpose of this book is to delineate the current understanding of the immune response to critical injury on the one hand, and lay a foundation on which we can understand and apply therapeutic advances in the management of this altered immunity on the other hand. Models of critical injuries have been successfully used to unravel the pathophysiologic processes during sepsis shock, severe trauma or major operations. Though basic research revealed several promising immunomodulating agents for the treatment of sepsis, such as neutralizing antibodies against the various inflammatory mediators involved in the exaggerated immune response during sepsis, most clinical trials evaluating the efficacy of these new immunomodulating agents in septic patients showed disappointing results. Why is it that these new innovative strategies did not work in the clinical arena while they proved to be very effective in the laboratory? In chapter 1 the several explanations for this discrepancy are discussed. The lungs of critically ill patients are at a constant threat of diverse inflammatory reactions. First, critically ill patients may develop acute lung injury or the acute respiratory distress syndrome, which can be the result of either a pulmonary insult, like pneumonia or direct trauma, or an indirect insult, such as sepsis or shock. Although frequently mandatory and life saving, mechanical ventilation puts patients at additional risks for secondary pulmonary inflammatory processes. Indeed, mechanically ventilated patients are prone to pneumonia (so called ventilator associated pneumonia), causing substantial additional morbidity and mortality. But mechanical ventilation may aggravate pulmonary inflammation (so called ventilator associated lung injury), which leads to a decreased change of survival. Recent reports even suggest that mechanical ventilation may initiate lung injury by itself. Mechanical ventilation may also contribute to the development of multiple organ failure. Causative immunological mechanisms include the concept suppression of peripheral immune responses, suggesting several potential therapeutic approaches. In chapter 2 the concepts of biotrauma, and loss of compartmentalization with mechanical ventilation are discussed. The proposed mechanisms linking mechanical ventilation to multiple organ failure suggest several novel therapeutic approaches. Severe systemic inflammatory response are almost invariably associated with disturbances in the blood clotting system, leading to the establishment of a procoagulant milieu. It is increasingly recognized that inflammation induced coagulation is not only encountered in the systemic circulation, but also on a local level, i.e. in the organs. Indeed, lung injury eliciting pulmonary inflammation is also characterized by a disturbed haemostatic balance, however mainly restricted to the bronchoalveolar compartment. Disturbances in pulmonary coagulopathy are discussed with regard to sepsis and lung injury in chapter 3. Adequate and timely detection of pulmonary inflammatory processes is severely hampered in clinical practice. Indeed, clinical manifestations of acute lung injury or the acute respiratory distress syndrome include rapid onset of bilateral chest radiographic consolidations consistent with edema and critical hypoxemia these clinical criteria, however, are at times hard to recognize. Similar diagnostic problems apply for the diagnosis of pneumonia in mechanically ventilated patients. In addition, neither chest radiograph findings nor clinical parameters can be used to monitor the effects of mechanical ventilation (i.e., the development of ventilator associated lung injury) in individual patients. A role for several types of biological markers for pulmonary injury in critically ill patients can be suggested. These include proteins that detect damage to the alveolar epithelium and pulmonary endothelium or increased permeability of the air blood barrier as well as recently discovered biological markers of infection. Examples of such biological markers are discussed in chapter 4. Corticosteroids were introduced in the treatment of severe infection mid last century. Several randomized controlled trials of high dose corticosteroids given for a short period of time in the early course of severe sepsis or acute respiratory distress syndrome did not show benefit. The link between septic shock and adrenal insufficiency and systemic inflammation induced corticoid receptor resistance prompted renewed interest of a replacement therapy with low doses of corticosteroids during longer periods. The key role of corticosteroids in the host response to critical injury is reviewed in chapter 5. In this chapter new validated indications of corticosteroids treatment in the ICU are presented. Toll like receptors are essential in the host defense against microorganisms they are the first to detect host invasion by pathogens, and initiate immune responses. Toll like receptors form the crucial link between the innate and adaptive immune systems. Chapter 6 focuses on the new insights in the pathogenesis of sepsis that is offered by the discovery of the Toll like receptors and its possible implications for intensive care medicine. Manipulation of the Toll like receptor pathway has great therapeutic potential the first clinical trials that evaluate the use of Toll like receptor modulating drugs in sepsis are being performed. Endothelial cells participate in many homeostatic processes, including control of vasomotor tone, trafficking of cells and nutrients, maintenance of blood fluidity, and regulation of permeability. During critical injury endothelial cells can be viewed as both a victim as well as a perpetrator of the inflammatory response. Chapter 7 summarizes endothelial physiology and pathophysiology and discusses both endothelial injury as well as the role of the endothelium in orchestrating the host response during injury, specifically sepsis. The potential value of the endothelium as a target for future therapy is discussed. Chapter 8 deals with one of these therapeutic options that influence endothelial activation and function. Intensive insulin therapy aiming at strict regulation of glucose concentration in critically ill patients, has gained much interest in recent years in view of its beneficial effects on morbidity and mortality. Intensive insulin therapy has been shown to reduce endothelial activation and end-organ dysfunction in patients with prolonged critical illness, but also affects the inflammatory process itself by anti-inflammatory effects, the preservation of mitochondrial ultrastructure, and maintaining cellular integrity.
Effect Of Red Cell Transfusion On The Host Immune Response In Critically Ill Patients
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Author : Maike Eline van Hezel
language : en
Publisher:
Release Date : 2020
Effect Of Red Cell Transfusion On The Host Immune Response In Critically Ill Patients written by Maike Eline van Hezel and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020 with categories.
Immunological Screening And Immunotherapy In Critically Ill Patients With Abdominal Infections
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Author : Eugen Faist
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-12-06
Immunological Screening And Immunotherapy In Critically Ill Patients With Abdominal Infections written by Eugen Faist and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-12-06 with Medical categories.
Over two decades an abundance of knowledge has been accumulated focus ing on the understanding of the molecular and cellular pathomechanisms of stressful conditions like systemic inflammation and sepsis. We have learned that there is a clear correlation between the magnitude of the inciting traumatic event and the degree of inflammatory dysbalance. The immunoinflammatory disintegration comprises a simultaneous col lapse of the otherwise very smoothly balanced pro- and antiinflammatory vectors of cytokine regulation. Most recently, we understood that it is predominantly the dysregulation of antiinflammatory mediators that plays a pivotal role for the phenomenon of trauma-induced depression or paralysis of cell-mediated immune responses. The substantial intellectual and logistic investments of numerous investi gators towards understanding the biology of sepsis inevitably lead us towards a rewarding status in terms of reaching spheres of clinical relevance. From the evolutionary collection of a multitude of ex-vivo and in-vivo immuno mechanistic parameters, some were found to represent most significant bio logical markers to support the clinician to characterize better the severity of inflammatory illness and to predict outcome. Chapter one of this book, authored by G. Grass and E.A.M. Neugebauer, analyses elegantly our current knowledge on the assessment of the immuno logical status in terms of risk and prognosis of sepsis.
Immunology And Infectious Disease
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Author : Lesley A. Doughty
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-12-06
Immunology And Infectious Disease written by Lesley A. Doughty and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-12-06 with Medical categories.
This unique volume provides a mechanistic look at key aspects of the inflammatory response seen in critical illness. Key cells and mediators involved in the innate inflammatory response and the pathways employed to combat infection or respond to injury are emphasized. It has become clear that a delicate balance exists to allow eradication of infection with minimal immune-mediated tissue injury in the process. For this reason an up-to-date discussion of how the inflammatory response down regulates itself has been included. The inflammatory response in the critically ill is vastly different than in healthy hosts. For this reason, discussions about the mechanisms of pharmacologic immune suppression and other less commonly considered immunomodulated states seen frequently in critical care medicine have been included. Given the differences in immune function seen in critical illness, the importance of considering the immune system an organ whose function must be monitored and optimized for the best possible outcome has been highlighted. In addition, we have included up-to-date discussions of prevention and diagnostic approaches to extremely common infectious entities which must be monitored for and treated appropriately in the setting of critical illness induced immune dysfunction.
Immunological Screening And Immunotherapy In Critically Ill Patients With Abdominal Infections
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Author : Eugen Faist
language : en
Publisher:
Release Date : 2001-02-23
Immunological Screening And Immunotherapy In Critically Ill Patients With Abdominal Infections written by Eugen Faist and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2001-02-23 with categories.
Critical Care Focus 10 Inflammation And Immunity
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Author : Helen Galley
language : en
Publisher: BMJ Books
Release Date : 2003-01-06
Critical Care Focus 10 Inflammation And Immunity written by Helen Galley and has been published by BMJ Books this book supported file pdf, txt, epub, kindle and other format this book has been release on 2003-01-06 with Medical categories.
This issue of the critical care focus series addresses aspects of the immune and inflammatory responses relevant to critical illness. It includes overviews of neutrophil function, apoptosis, metalloproteinases and T cells. In addition, the concept of immune paralysis as a contributor to the mortality of sepsis is discussed, and a comprehensive report on the current thinking regarding glucocorticoid therapy. There is also an interesting chapter describing the 'killer within' - the way in viruses are able to modulate host immune responses to their own benefit.
Host Response And Outcome Of Sepsis In The Critically Ill
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Author : Maryse A. Wiewel
language : en
Publisher:
Release Date : 2017
Host Response And Outcome Of Sepsis In The Critically Ill written by Maryse A. Wiewel and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017 with categories.
Sepsis is a major cause of morbidity and mortality worldwide. It is a life-threatening condition that is characterized by a dysregulated host response to infection, leading to tissue and organ damage. Important features of the septic host response include activation of the cytokine network, the vascular endothelium and the coagulation system. This thesis describes studies with specific research questions within the MARS cohort, a large prospective observational study conducted in the intensive care units of the Academic Medical Center in Amsterdam and the University Medical Center Utrecht. We studied several “external” and host factors that might influence sepsis outcome and the accompanying host response, particularly chronic medication (antiplatelet agents, calcium channel blockers, statins) and comorbidity (HIV infection). None of these factors had a major impact on the host response to sepsis, while only the use of calcium channel blockers was associated with an altered (improved) outcome. In addition, we examined the influence of hypothermia, an acute manifestation of severe infection, on sepsis outcome and the host response, revealing an independent association between hypothermia and mortality without evidence for an altered immune response. Finally, the research presented in this thesis provides evidence that a disturbed host response towards a more hyperinflammatory phenotype renders sepsis patients more vulnerable to develop a secondary infection while on the intensive care unit.
Immune Function And Risk For Complications After Pediatric Cardiac Surgery
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Author : Kristin Cora Greathouse
language : en
Publisher:
Release Date : 2018
Immune Function And Risk For Complications After Pediatric Cardiac Surgery written by Kristin Cora Greathouse and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018 with Heart categories.
Critical illness induced immune suppression is a phenomenon that places critically ill patients at risk for serious complications during their ICU stay. There is evidence to suggest in many forms of critical illness both arms of the immune system (innate and adaptive) are affected. Immune suppression can be quantified using immune monitoring strategies in a laboratory setting, and there are agents clinically available that show promise in being able to restore immune function in this setting. This dissertation provides a comprehensive review of critical illness induced immune suppression (Chapter 1), places this phenomenon in the context of the pediatric critical care environment and patient through the modeling of a new theoretical framework (Chapter 2), and describes how measurements of both innate and adaptive immune function were utilized in a specific population (critically ill pediatric patients with congenital heart disease) to predict those who would develop immune suppression in the context of important clinical complications such as development of infection and prolonged organ dysfunction (Chapter 3). In summary, both innate and adaptive immune function were found to be suppressed after cardiac surgery, and for certain measures, clinical cut-offs were able to be generated for both development of nosocomial infection and prolonged organ dysfunction. Overall, this study provides the most comprehensive evaluation of immune function to date in this population, and is a critical first step in understanding the timing and significance immune suppression after cardiac surgery.