- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Part 14.1 Physiology
- Part 14.2 Organ-specific biomarkers
- Part 14.3 Host response
- Chapter 303 The host response to infection in the critically ill
- Chapter 304 The host response to trauma and burns in the critically ill
- Chapter 305 The host response to hypoxia in the critically ill
- Chapter 306 Host–pathogen interactions in the critically ill
- Chapter 307 Coagulation and the endothelium in acute injury in the critically ill
- Chapter 308 Ischaemia-reperfusion injury in the critically ill
- Chapter 309 Repair and recovery mechanisms following critical illness
- Chapter 310 Neural and endocrine function in the immune response to critical illness
- Chapter 311 Adaptive immunity in critical illness
- Chapter 312 Immunomodulation strategies in the critically ill
- Chapter 313 Immunoparesis in the critically ill
- Part 14.4 Anaphylaxis
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 1449) The host response to infection in the critically ill
- Chapter:
- (p. 1449) The host response to infection in the critically ill
- Author(s):
W. Joost Wiersinga
and Tom van der Poll
- DOI:
- 10.1093/med/9780199600830.003.0303
Infection continues to be a leading cause of intensive care unit death. The host response to infection can be seen as a pattern recognition receptor (PRR)-mediated dysregulation of the immune system following pathogen invasion in which a careful balance between inflammatory and anti-inflammatory responses is vital. A measured and rapid response to microbial invasion is essential to health. The same immunological and coagulation systems that protect against localized infection can act to our disadvantage when these systems are activated systemically during generalized microbial infection. Toll-like receptors (TLR), the inflammasomes and other PRRs initiate the host response after recognition of pathogen-associated-molecular-patterns (PAMPs) or endogenous danger-associated-molecular-patterns (DAMPs). The systemic host response to infection will result in activation of coagulation, downregulation of physiological anticoagulant mechanisms, and inhibition of fibrinolysis. Further dissection of the role of host–pathogen interactions, the cytokine response, the coagulation cascade and their multidirectional interactions in sepsis should lead towards the development of new therapeutic approaches in the critically ill who are faced with infection.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Part 14.1 Physiology
- Part 14.2 Organ-specific biomarkers
- Part 14.3 Host response
- Chapter 303 The host response to infection in the critically ill
- Chapter 304 The host response to trauma and burns in the critically ill
- Chapter 305 The host response to hypoxia in the critically ill
- Chapter 306 Host–pathogen interactions in the critically ill
- Chapter 307 Coagulation and the endothelium in acute injury in the critically ill
- Chapter 308 Ischaemia-reperfusion injury in the critically ill
- Chapter 309 Repair and recovery mechanisms following critical illness
- Chapter 310 Neural and endocrine function in the immune response to critical illness
- Chapter 311 Adaptive immunity in critical illness
- Chapter 312 Immunomodulation strategies in the critically ill
- Chapter 313 Immunoparesis in the critically ill
- Part 14.4 Anaphylaxis
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care