- 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. 1459) The host response to hypoxia in the critically ill
- Chapter:
- (p. 1459) The host response to hypoxia in the critically ill
- Author(s):
Raghavan Raju
and Irshad H. Chaudry
- DOI:
- 10.1093/med/9780199600830.003.0305
The hypoxic response of the host is complex. While the oxygen-sensing intracellular machinery attempts to restore cellular homeostasis by augmenting respiration and blood flow, events such as severe haemorrhage lead to whole body hypoxia and decreased mitochondrial function. Immunological perturbations following severe haemorrhage may result in multiple organ dysfunction and sepsis, while impaired perfusion may lead to microvascular injury and local hypoxia. Trauma-haemorrhage or hypoxic exposure in animals causes a systemic inflammatory response, decreased antigen presentation by peritoneal macrophages, hypoxaemia and initiation of endoplasmic reticulum stress. In response, the protein level of the oxygen-sensing transcription factor, hypoxia inducible factor (HIF)-1 increases; this leads to the regulation of expression of a number of genes resulting in decreased mitochondrial ATP production, but enhanced glycolytic processes, thus shifting the energy balance. In addition, sustained tissue hypoxia leads to increased free radical production and cellular apoptosis. Though the initial host response to hypoxia may be protective, sustained hypoxia becomes detrimental to the tissues and the organism as a whole.
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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