TY - JOUR
T1 - Chronic Critical Illness and Persistent Inflammation
T2 - What can we Learn from the Elderly, Injured, Septic, and Malnourished?
AU - Nomellini, Vanessa
AU - Kaplan, Lewis J.
AU - Sims, Carrie A.
AU - Caldwell, Charles C.
N1 - Publisher Copyright:
© Copyright 2017 by the Shock Society.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Patients in the intensive care unit (ICU) who develop chronic critical illness significantly stress the clinical capacity and financial resources of healthcare systems. Although vast improvements have been made in critical care management, outcomes for this ICU subset remain poor. A hallmark for patients who progress to chronic critical illness is the development of persistent inflammation and immunosuppression. The risk factors associated with the development of chronic critical illness include increased age, medical comorbidities, severe injury, septic shock, and malnutrition. Interestingly, each of these clinical states bears strikingly similar immune defects, often resulting in the activation of a persistent inflammatory state. Strategies aimed at the prevention or early recognition of this state of immune compromise may help improve outcomes for these individuals and minimize the number who progress to chronic critical illness. This review explores the current knowledge regarding the immune defects associated with the development of persistent inflammation, the ways in which it can manifest clinically, attempted therapeutic interventions to date, and future insights into improving outcomes for this patient population.
AB - Patients in the intensive care unit (ICU) who develop chronic critical illness significantly stress the clinical capacity and financial resources of healthcare systems. Although vast improvements have been made in critical care management, outcomes for this ICU subset remain poor. A hallmark for patients who progress to chronic critical illness is the development of persistent inflammation and immunosuppression. The risk factors associated with the development of chronic critical illness include increased age, medical comorbidities, severe injury, septic shock, and malnutrition. Interestingly, each of these clinical states bears strikingly similar immune defects, often resulting in the activation of a persistent inflammatory state. Strategies aimed at the prevention or early recognition of this state of immune compromise may help improve outcomes for these individuals and minimize the number who progress to chronic critical illness. This review explores the current knowledge regarding the immune defects associated with the development of persistent inflammation, the ways in which it can manifest clinically, attempted therapeutic interventions to date, and future insights into improving outcomes for this patient population.
KW - Immune suppression
KW - persistent inflammation
KW - PICS
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U2 - 10.1097/SHK.0000000000000939
DO - 10.1097/SHK.0000000000000939
M3 - Review article
C2 - 28682945
AN - SCOPUS:85021869040
SN - 1073-2322
VL - 49
SP - 4
EP - 14
JO - Shock
JF - Shock
IS - 1
ER -