- 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. 1476) Repair and recovery mechanisms following critical illness
- Chapter:
- (p. 1476) Repair and recovery mechanisms following critical illness
- Author(s):
Geoffrey Bellingan
and Brijesh V. Patel
- DOI:
- 10.1093/med/9780199600830.003.0309
Inflammation is the beneficial host response to foreign challenge or tissue injury that ultimately leads to the restoration of tissue structure and function. Critical illness is associated with an overwhelming and prolonged inflammatory activation. Resolution of the inflammatory response is an active process that requires removal of the inciting stimuli, cessation of the pro-inflammatory response, a timely coordinated removal of tissue leukocyte infiltration, a conversion from ‘toxic’ to reparative tissue environment, and restoration of normal tissue structure and function. Mortality may result from deficits in these resolution mechanisms. Improved delivery of critical care through prevention of harm and removal of stimuli has already delivered significant mortality benefits. Most critically-ill patients present with uncontrolled inflammation, hence anti-inflammatory strategies ameliorating this response are likely to be too late and thus futile. Rather, strategies augmenting endogenous pathways involved in the control and appropriate curtailment of such inflammatory responses may promote resolution, repair, and catabasis. Recent evidence showing that inflammation does not simply ‘fizzle out’, but its resolution involves an active and coordinated series of events. Dysfunction of these resolution checkpoints alters the normal inflammatory pathway, and is implicated in the induction and maintenance of states such as ARDS and sepsis. Improved understanding of resolution biology should provide translational pathways to not only improve survival, but also to prevent long-term morbidity resulting from tissue damage.
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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