Major surgery and the immune system: from pathophysiology to treatment.

Abstract:

PURPOSE OF REVIEW:The purpose of this review is to provide an overview of the immune response to major surgery, and the ways in which it may be modulated to improve postoperative outcomes. RECENT FINDINGS:Data from patients who have undergone a variety of tissue injuries (surgery, burns, sepsis, trauma) have shown the presence of a conserved 'genomic storm' that alters the leukocyte transcriptome, with upregulation of the innate immune response and concomitant downregulation of the adaptive immune response. The innate and adaptive immune systems are often regarded largely distinct. However, more recent evidence suggests there are critical connections between the two arms of the immune response, whereby innate immune cells are able to suppress the adaptive response. SUMMARY:The immune system is critical to the host response to tissue injury occurring due to surgery. However, the physiological processes required to resolve the surgical insult can also contribute to sequelae such as cognitive decline, pneumonia and acute kidney injury. Our understanding of the immune pathogenesis underlying these complications is improving, leading to interest in the development of immunomodulatory therapies, which aim to permit host defence whilst ameliorating postoperative complications.

journal_name

Curr Opin Crit Care

authors

Shankar Hari M,Summers C

doi

10.1097/MCC.0000000000000561

subject

Has Abstract

pub_date

2018-12-01 00:00:00

pages

588-593

issue

6

eissn

1070-5295

issn

1531-7072

journal_volume

24

pub_type

杂志文章,评审
  • Prerenal failure: from old concepts to new paradigms.

    abstract:PURPOSE OF REVIEW:Prerenal failure is used to designate a reversible form of acute renal dysfunction. However, the terminology encompasses several different conditions that vary considerably. The lack of a widely accepted definition for prerenal failure makes it impossible to determine the epidemiology, natural history...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章

    doi:10.1097/MCC.0b013e328332f6e3

    authors: Macedo E,Mehta RL

    更新日期:2009-12-01 00:00:00

  • New ways to reduce unnecessary variation and improve outcomes in the intensive care unit.

    abstract::The care of critically ill patients and the advent of the modern day intensive care unit (ICU) present a large person power and cost burden to society. The high cost of critical care is attributed to high overhead expenses (eg, experienced staff and equipment), high resource utilization (eg, pharmaceutical resources, ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200108000-00015

    authors: Holcomb BW,Wheeler AP,Ely EW

    更新日期:2001-08-01 00:00:00

  • Implications of arterial pressure variation in patients in the intensive care unit.

    abstract::Positive-pressure ventilation alters stroke volume by transiently increasing intrathoracic pressure and thereby decreasing preload. This phasic variation in stroke volume results in a cyclic fluctuation in arterial pressure with a phase length equal to the respiratory rate. Measuring ventilation-induced arterial press...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200106000-00012

    authors: Gunn SR,Pinsky MR

    更新日期:2001-06-01 00:00:00

  • Implementing the Kidney Disease: Improving Global Outcomes/acute kidney injury guidelines in ICU patients.

    abstract:PURPOSE OF REVIEW:Acute kidney injury (AKI) is a frequent finding in critically ill patients and is associated with adverse outcomes. With the purpose of improving outcome of AKI, the Kidney Disease: Improving Global Outcomes (KDIGO) group, a group of experts in critical care nephrology, has presented a set of guidelin...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000039

    authors: Hoste EA,De Corte W

    更新日期:2013-12-01 00:00:00

  • Hemodynamic monitoring by echocardiography in the ICU: the role of the new echo techniques.

    abstract:PURPOSE OF REVIEW:The present review will discuss the usefulness of ultrasound in the ICU in assessing hemodynamic instability in various critical care conditions. We will discuss how to interpret echocardiographic findings in critically ill patients including the physiological consequences of mechanical ventilation. ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32830e6d81

    authors: Salem R,Vallee F,Rusca M,Mebazaa A

    更新日期:2008-10-01 00:00:00

  • Advances in burn care.

    abstract:PURPOSE OF REVIEW:This article reviews and critiques new developments in the critical care of burn patients. RECENT FINDINGS:The practice of restrictive transfusion is slowly gaining traction. Abdominal compartment syndrome is associated with resuscitation volumes of 300 ml/kg per 24 h, and percutaneous decompression ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e328263888f

    authors: Namias N

    更新日期:2007-08-01 00:00:00

  • The epithelium in acute lung injury/acute respiratory distress syndrome.

    abstract:PURPOSE OF REVIEW:The mechanisms of epithelial injury in acute lung injury/acute respiratory distress syndrome have been of interest since the syndrome was first described. Cell therapies to replace injured epithelium are a futuristic dream; however, there is ongoing research to achieve this goal. We review research re...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3282f417a0

    authors: Gropper MA,Wiener-Kronish J

    更新日期:2008-02-01 00:00:00

  • Mental and physical disorders after ICU discharge.

    abstract:PURPOSE OF REVIEW:Research and studies related to the long-term consequences of intensive care are increasing. This review focuses on some of the most recent knowledge in this field. RECENT FINDINGS:Still studies regarding the health-related quality of life (HRQOL) in survivors after intensive care are frequently publ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32833cc90b

    authors: Flaatten H

    更新日期:2010-10-01 00:00:00

  • Update on progress in the international, multicenter, randomized, controlled trial of corticosteroids after significant head injury (Medical Research Council CRASH Trial).

    abstract:PURPOSE OF REVIEW:To provide an update on the progress of the multicenter, randomized, controlled trial of corticosteroids after significant head injury (CRASH). RECENT FINDINGS:After a successful pilot phase, the main phase of the CRASH Trial began in March 2001. By June 2002, 107 hospitals from 31 countries were par...

    journal_title:Current opinion in critical care

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00075198-200304000-00003

    authors: MRC CRASH Trial National Coordinators.

    更新日期:2003-04-01 00:00:00

  • Insights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaning.

    abstract:PURPOSE OF REVIEW:Mechanical ventilation is a common intervention provided by pediatric intensivists. This fact notwithstanding, the management of mechanical ventilation in pediatrics is largely guided by a few pediatric trials along with careful interpretation and application of adult data. RECENT FINDINGS:A low tida...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32801297f9

    authors: Turner DA,Arnold JH

    更新日期:2007-02-01 00:00:00

  • Critical care lessons from severe acute respiratory syndrome.

    abstract:PURPOSE OF REVIEW:Severe acute respiratory syndrome (SARS) is a new disease that caused large outbreaks in several countries in the first half of 2003, resulting in infection in more than 8000 people and more than 900 deaths. During that time, a large body of literature rapidly emerged describing the clinical disease, ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200402000-00009

    authors: Lapinsky SE,Granton JT

    更新日期:2004-02-01 00:00:00

  • Advancements in the critical care management of status epilepticus.

    abstract:PURPOSE OF REVIEW:Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000392

    authors: Bauerschmidt A,Martin A,Claassen J

    更新日期:2017-04-01 00:00:00

  • Prompt antibiotic administration and goal-directed hemodynamic support in patients with severe sepsis and septic shock.

    abstract:PURPOSE OF REVIEW:Treatment protocols targeting the rapid administration of appropriate antibiotics and hemodynamic support are now recognized as a key measure in the initial care of patients presenting with severe sepsis and septic shock. Strong evidence exists showing that time parameters, particularly in the emergen...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3282e7d8e1

    authors: Nobre V,Sarasin FP,Pugin J

    更新日期:2007-10-01 00:00:00

  • Role of open-lung biopsy in acute respiratory distress syndrome.

    abstract:PURPOSE OF REVIEW:When classic examinations such as bronchoalveolar lavage are not contributory in the etiologic diagnosis of unresolving acute respiratory distress syndrome, surgical lung biopsy would appear to be useful to determine the specific cause, particularly infection or postaggressive fibrosis, which could be...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3282f33e42

    authors: Donati SY,Papazian L

    更新日期:2008-02-01 00:00:00

  • Toxicologic issues during cardiopulmonary resuscitation.

    abstract:PURPOSE OF REVIEW:The following review intends to outline the unique aspects of providing cardiopulmonary resuscitation for the poisoned patient and highlights both current practice and new therapies that apply to toxicologic cases. RECENT FINDINGS:Although there are few prospective randomized studies to further evide...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32814b040c

    authors: Givens ML,O'Connell E

    更新日期:2007-06-01 00:00:00

  • Current use of the pulmonary artery catheter.

    abstract:PURPOSE OF REVIEW:The pulmonary artery catheter is one of the most scrutinized monitors used in intensive care today. Pulmonary artery catheter use is declining due to limited demonstrated beneficial outcomes and the advancement of less invasive monitoring. This study discusses the current use of the pulmonary artery c...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32832b302b

    authors: Greenberg SB,Murphy GS,Vender JS

    更新日期:2009-06-01 00:00:00

  • Mechanical ventilation strategies for the surgical patient.

    abstract:PURPOSE OF REVIEW:To summarize clinical evidence for intraoperative ventilation settings, which could protect against postoperative pulmonary complications (PPCs) in surgical patients with uninjured lungs. RECENT FINDINGS:There is convincing evidence for protection against PPCs by low tidal volumes: benefit was found ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000215

    authors: Schultz MJ,Abreu MG,Pelosi P

    更新日期:2015-08-01 00:00:00

  • Reappraising Starling: the physiology of the microcirculation.

    abstract:PURPOSE OF REVIEW:Vascular permeability is traditionally explained by Starling's principle, describing two opposing forces across the endothelial cell line to maintain compartments in balance. Several contradictions to this principle have recently questioned its validity. RECENT FINDINGS:Hydraulic conductivity is kept...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3283632d5e

    authors: Jacob M,Chappell D

    更新日期:2013-08-01 00:00:00

  • Enhanced recovery pathways as a way to reduce surgical morbidity.

    abstract:PURPOSE OF REVIEW:The aim of this review is to summarize important publications in enhanced recovery during 2010-2011 and to highlight key themes. Specifically, we focus on updated systematic reviews of high-quality clinical trials of enhanced recovery in colorectal surgery, exemplar studies of enhanced recovery in oth...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3283558968

    authors: Grocott MP,Martin DS,Mythen MG

    更新日期:2012-08-01 00:00:00

  • Neuromuscular sequelae of critical illness.

    abstract:PURPOSE OF REVIEW:To investigate the impact of critical illness polyneuropathy and critical illness myopathy on short-term and long-term patient outcome. RECENT FINDINGS:In the acute-care setting, critical illness polyneuropathy and critical illness myopathy are important causes of acute paralysis in critically ill co...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccx.0000168530.30702.3e

    authors: Latronico N,Shehu I,Seghelini E

    更新日期:2005-08-01 00:00:00

  • The effects of mechanical ventilation on hepato-splanchnic perfusion.

    abstract:PURPOSE OF REVIEW:Mechanical ventilation is a cornerstone of ICU treatment. Because of its interaction with blood flow and intra-abdominal pressure, mechanical ventilation has the potential to alter hepato-splanchnic perfusion, abdominal organ function and thereby outcome of the most critically ill patients. RECENT FI...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章

    doi:10.1097/MCC.0b013e3283374b1c

    authors: Jakob SM

    更新日期:2010-04-01 00:00:00

  • Acetylcysteine for radiocontrast nephropathy.

    abstract::Radiocontrast nephropathy may in part be mediated by generation of reactive oxygen species causing direct toxic damage to renal tubular epithelial cell and renal medullary ischemia. Data from experimental studies indicated that antioxidants, eg, acetylcysteine, may prevent radiocontrast-induced nephropathy. Recently, ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200112000-00004

    authors: Tepel M,Zidek W

    更新日期:2001-12-01 00:00:00

  • Novelties in pharmacological management of cardiopulmonary resuscitation.

    abstract:PURPOSE OF REVIEW:The ultimate goal of cardiopulmonary resuscitation is long-term neurologically intact survival. Despite numerous well-designed studies, the medications currently used in advanced cardiac life support have not demonstrated success in this regard. This review describes the novel therapeutics under inves...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e328364d7b1

    authors: Bartos JA,Yannopoulos D

    更新日期:2013-10-01 00:00:00

  • Effect of ICU interventions on gastrointestinal motility.

    abstract:PURPOSE OF REVIEW:Early detection of gastrointestinal motility disturbances is a major goal to reduce the incidence of this potentially disastrous event by prophylactic managements and early goal-directed therapy in patients at risk. RECENT FINDINGS:Gastroparesis frequently results in the inability to feed critically ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3283356679

    authors: Fruhwald S,Kainz J

    更新日期:2010-04-01 00:00:00

  • The timing of spinal stabilization in polytrauma and in patients with spinal cord injury.

    abstract:PURPOSE OF REVIEW:Despite improved care of multiple injured patients, controversial data about the best time point for decompression and stabilization of spine fractures and spinal cord injuries are published. Some studies even question the value of surgical management. RECENT FINDINGS:In several mostly retrospective ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e328319650b

    authors: Schinkel C,Anastasiadis AP

    更新日期:2008-12-01 00:00:00

  • Nutritional assessment and support of the patient with acute heart failure.

    abstract:PURPOSE OF REVIEW:A significant number of patients hospitalized with heart failure are malnourished. Depletion of micronutrients, which is known to occur in heart failure for a variety of reasons, may contribute to myocardial abnormalities noted in heart failure. In this review, we focus on nutritional supplementation ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32833e10d4

    authors: Sarma S,Gheorghiade M

    更新日期:2010-10-01 00:00:00

  • Postoperative sepsis.

    abstract:PURPOSE OF REVIEW:Postoperative sepsis is a major cause of surgical associated morbidity and mortality. Our goal is to describe its incidence, pathophysiology, and contributing factors. In addition, we will review preventive measures and treatment options that may possibly reduce its healthcare burden. RECENT FINDINGS...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e328348bee2

    authors: Fried E,Weissman C,Sprung C

    更新日期:2011-08-01 00:00:00

  • ICU delirium: an update.

    abstract:PURPOSE OF REVIEW:Delirium is frequently encountered in the ICU and is associated with significant adverse outcomes. The increasingly recognized consequences of ICU delirium should enhance efforts to improve recognition and management of this serious problem. We aim to review the recent literature on ICU delirium, incl...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32835132b9

    authors: Jones SF,Pisani MA

    更新日期:2012-04-01 00:00:00

  • Critical illness polyneuropathy.

    abstract::Critical illness polyneuropathy (CIP) is a syndrome that was first extensively described in the early 1980s, mainly in patients with failure to wean from mechanical ventilation. The syndrome is further characterized by limb muscle weakness, usually more pronounced distally than proximally, and is often accompanied by ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200208000-00006

    authors: van Mook WN,Hulsewé-Evers RP

    更新日期:2002-08-01 00:00:00

  • ICU-based rehabilitation and its appropriate metrics.

    abstract:PURPOSE OF REVIEW:Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early rehabilitation of ICU patients has recently been identified as an important focus for interdisciplinary ICU teams. However, the amount of rehabilitation...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e328357f022

    authors: Gosselink R,Needham D,Hermans G

    更新日期:2012-10-01 00:00:00