- 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. 1488) Immunomodulation strategies in the critically ill
- Chapter:
- (p. 1488) Immunomodulation strategies in the critically ill
- Author(s):
Aline B. Maddux
and Gordon R. Bernard
- DOI:
- 10.1093/med/9780199600830.003.0312
Severe sepsis is a hyperimmune response to an infectious stimulus resulting in a surge of cytokines and mediators of inflammation. High circulating levels of pro-inflammatory cytokines lead to shock, multiple organ failure, and death in septic patients. It has been recognized that patients with sepsis progress into a state of immune paralysis characterized by immune cell apoptosis and high levels of anti-inflammatory cytokines… Anti-inflammatory cytokines suppress production of pro-inflammatory cytokines and inhibit monocytes from presenting antigens to other immune cells. Immune paralysis probably leads to the patient’s inability to clear infections resulting in the delayed mortality observed in some septic patients. Beneficial therapies for sepsis are limited to the mechanical eradication of the source of infection, antibiotics, the judicious use of fluids to support organ perfusion, and oxygen supplementation. Strategies to counteract the hyper- and hypo-immune phases of sepsis have been tried thus far with only minimal success.
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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