Immunomodulation in the Critically Ill Surgical Patient
The critically ill surgical patient is at high risk for immune dysfunction. Severe stress states (such as multiple trauma and sepsis) produce a deleterious, potentially lethal, immunologic dichotomy. The uncontrolled disseminated activation of the normally protective immunoinflammatory cascades produces a “malignant systemic inflammation” that leads to diffuse multiple organ bystander injury, progressive organ dysfunction, and ultimate sequential organ failure referred to as multiple organ failure syndrome (MOFS) [1–3]. Concomitantly, this “malignant systemic inflammation” induces a simultaneous prolonged and excessive down-regulatory and ultimately immunosuppressive response. In addition, the diffuse activation of these inflammatory cascades leads to a consumptive depletion of the normal protective mechanisms of the immune system. Thus, the appropriate immunomodulation of the critically ill patient will not only prevent MOFS but also maintain normal host defense mechanisms and prevent nosocomial infections, which further induce the malignant systemic inflammatory response, and ultimate organ failure. A major challenge at present is the inability to identify the most critical abnormal components of the immunologic response present in the critically ill patient.
KeywordsPlatelet Activate Factor Arachidonic Acid Metabolite Platelet Activate Factor Receptor Severe Stress State Platelet Activate Factor Receptor Antagonist
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- 1.Maier RV (1993) The “angry” macrophage and its impact on host response mechanisms. In: Faist E, Meakins JL, Schildberg, FW (eds) Host defense dysfunction in trauma, shock and sepsis. Springer, Berlin Heidelberg New YorkGoogle Scholar
- 6.Redl H, Dinges HP, Buurman WA, van der Linden CJ et al. (1991) Expression of endothelial leukocyte adhesion molecule-1 in septic but not traumatic/ hypovolemic shock in the baboon. Am J Pathol (139)2:461–466Google Scholar
- 9.Wakabayashi G, Gelfand JA, Burke JF et al. (1991) A specific receptor antagonist for interleukin-1 prevents Escherichia coli-induced shock in rabbits. EASEBJ 5:338–343Google Scholar
- 16.Maier RV (1992) What’s new in surgery — critical care metabolism. Bull Am Coll Surg 77:22–26Google Scholar
- 20.Thompson WA, Coyle SM, Lazarus D et al. (1991) The metabolic effects of a continuous infusion of insulin-like growth factor (IGF-1) in parenterally fed men. Surg Forum 42:23–25Google Scholar
- 21.Hong RW, Robinson MK, Rounds JD et al. (1991) Glutamine protects the liver following corynebacterium parvum/endotoxin-induced hepatic necrosis. Surg Forum 42:1–3Google Scholar
- 22.Robinson MK, Hong RW, Rounds JD et al. (1991) Glutathione depletion enhances bacterial translocation and alters immunologic status. Surg Forum 42:65–67Google Scholar
- 23.Sato TT, Garcia IA, Maier RV (1992) Immunomodulation of cultured human monocytes by omega-3 fatty acid. Surg Forum 43:9–10Google Scholar
- 24.Griswold JA, Grogan JB, Metcalf J et al. (1991) The impact of dietary fish oil in endotoxin-induced stress. Surg Forum 42:9–11Google Scholar