Immunomodulation in the Critically Ill Surgical Patient

  • R. V. Maier
Conference paper


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.


Platelet Activate Factor Arachidonic Acid Metabolite Platelet Activate Factor Receptor Severe Stress State Platelet Activate Factor Receptor Antagonist 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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
  2. 2.
    Carrico CJ, Meakins JL, Maier RV et al. (1986) Multiple-organ-failure syndrome. Arch Surg 121:196–208PubMedCrossRefGoogle Scholar
  3. 3.
    Goris RJA, te Boekhorst TPA, Nuytinck JKS et al. (1985) Multiple organ failure: generalized autodestructive inflammation? Arch Surg 120:1109PubMedCrossRefGoogle Scholar
  4. 4.
    Henson PM, Larsen GL, Webster RO et al. (1982) Pulmonary microvascular alterations and injury induced by complement fragments: synergistic effect of complement activation, neutrophil sequestration, and prostaglandins. Ann NY Acad Sei 384:287–300CrossRefGoogle Scholar
  5. 5.
    Welbourn CRB, Goldman G, Paterson IS et al. (1991) Pathophysiology of ischemia reperfusion injury: central role of the neutrophil. Br J Surg 78:651–656PubMedCrossRefGoogle Scholar
  6. 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
  7. 7.
    Greenman RL, Schein RMH, Martin MA et al. (1991) A controlled clinical trial of E6 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. JAMA 266:1097–1102PubMedCrossRefGoogle Scholar
  8. 8.
    Ziegler EJ, Fisher CJ, Sprung CL et al. (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. N Engl J Med 324:429–436PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Dinarello CA (1984) Interleukin-1 and pathogenesis of the acute-phase response. N Engl J Med 311:1413–1418PubMedCrossRefGoogle Scholar
  11. 11.
    Tracey KJ, Beutler B, Lowry SF et al. (1986) Shock and tissue injury induced by recombinant human cachectin. Science 234:470–474PubMedCrossRefGoogle Scholar
  12. 12.
    Fletcher JR, Disimone AG, Earnest MA (1990) Platelet activating factor receptor antagonist improves survival and attenuates eicosanoid release in severe endo-toxemia. Ann Surg 211:312–316PubMedGoogle Scholar
  13. 13.
    Maier RV, Hahnel GB, Fletcher JR (1992) Platelet activating factor augments tumor necrosis factor and procoagulant activity. J Surg Res 52:258–264PubMedCrossRefGoogle Scholar
  14. 14.
    Hershman MJ, Polk HC Jr, Pietsch JD et al. (1988) Modulation of infection by gamma interferon treatment following trauma. Infect Immun 56:2412–2416PubMedGoogle Scholar
  15. 15.
    Faist E, Mewes A, Strasser T et al. (1988) Aeteration of monocyte function following major injury. Arch Surg 123:287–292PubMedCrossRefGoogle Scholar
  16. 16.
    Maier RV (1992) What’s new in surgery — critical care metabolism. Bull Am Coll Surg 77:22–26Google Scholar
  17. 17.
    Wilmore DW (1991) Catabolic illness: strategies for enhancing recovery. N Engl J Med 325:695–702PubMedCrossRefGoogle Scholar
  18. 18.
    Cerra FB (1991) Nutrient modulation of inflammatory and immune function. Am J Surg 161:230–234PubMedCrossRefGoogle Scholar
  19. 19.
    Fisher JE, Hasseigren PO (1991) Cytokines and glucocorticoids in the regulation of the “hepato-skeletal muscle axis” in sepsis. Am J Surg 6:266–271CrossRefGoogle Scholar
  20. 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. 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. 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. 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. 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

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • R. V. Maier

There are no affiliations available

Personalised recommendations