Collapse of the Microbiome, Emergence of the Pathobiome, and the Immunopathology of Sepsis.


:The definition of sepsis has been recently modified to accommodate emerging knowledge in the field, while at the same time being recognized as challenging, if not impossible, to define. Here, we seek to clarify the current understanding of sepsis as one that has been typically framed as a disorder of inflammation to one in which the competing interests of the microbiota, pathobiota, and host immune cells lead to loss of resilience and nonresolving organ dysfunction. Here, we challenge the existence of the idea of noninfectious sepsis given that critically ill humans never exist in a germ-free state. Finally, we propose a new vision of the pathophysiology of sepsis that includes the invariable loss of the host's microbiome with the emergence of a pathobiome consisting of both "healthcare-acquired and healthcare-adapted pathobiota." Under this framework, the critically ill patient is viewed as a host colonized by pathobiota dynamically expressing emergent properties which drive, and are driven by, a pathoadaptive immune response.


Crit Care Med


Critical care medicine


Alverdy JC,Krezalek MA




Has Abstract


2017-02-01 00:00:00














  • Transient coagulation abnormalities after incompatible blood transfusion.

    abstract::This report describes an unusual hemolytic transfusion reaction. A group O donor was inadvertently transfused with 100 ml of group A red cells during the course of plasmapheresis. Granulocytopenia, thrombocytopenia, hypofibrinogenemia and low levels of factors V, VIII, and IX developed immediately after the infusion. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: McKenna PJ,Scheinman HZ

    更新日期:1975-01-01 00:00:00

  • Are autopsy findings still relevant to the management of critically ill patients in the modern era?

    abstract:OBJECTIVES:The purpose of this study was to determine the accuracy of clinical diagnoses compared to autopsy findings in critically ill patients in the current medical era. DESIGN:We conducted a retrospective, blinded review of matched medical records and postmortem findings in patients who died between June 2006 and ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Fröhlich S,Ryan O,Murphy N,McCauley N,Crotty T,Ryan D

    更新日期:2014-02-01 00:00:00

  • Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients.

    abstract:OBJECTIVE:The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU). DESIGN:A prospective pre/post nonequivalent control group design was used for this performance improvement study. SETTING:Seventee...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Norton SA,Hogan LA,Holloway RG,Temkin-Greener H,Buckley MJ,Quill TE

    更新日期:2007-06-01 00:00:00

  • Importance of the infusion rate for the plasma expanding effect of 5% albumin, 6% HES 130/0.4, 4% gelatin, and 0.9% NaCl in the septic rat.

    abstract:OBJECTIVES:To compare the plasma volume (PV) expanding effect of a fast infusion rate with that of a slow infusion rate of a fixed volume of 5% albumin, of the synthetic colloids, 6% hydroxyethyl starch 130/0.4 and 4% gelatin, and of 0.9% NaCl in a rat sepsis model and to compare the plasma-expanding effect among these...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Bark BP,Persson J,Grände PO

    更新日期:2013-03-01 00:00:00

  • Ventriculo-Arterial Coupling Analysis Predicts the Hemodynamic Response to Norepinephrine in Hypotensive Postoperative Patients: A Prospective Observational Study.

    abstract:OBJECTIVES:The objectives of the present study were to evaluate, in patients with persistent arterial hypotension in the immediate postcardiac surgery period, the effects of norepinephrine infusion on ventriculo-arterial coupling, its determinants: arterial elastance and end-systolic ventricular elastance, and to test ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Guinot PG,Longrois D,Kamel S,Lorne E,Dupont H

    更新日期:2018-01-01 00:00:00

  • Quality of communication in the ICU and surrogate's understanding of prognosis.

    abstract:OBJECTIVE:Although misperceptions about prognosis by surrogates in ICUs are common and influence treatment decisions, there is no validated, practical way to measure the effectiveness of prognostic communication. Surrogates' subjective ratings of quality of communication have been used in other domains as markers of ef...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Chiarchiaro J,Buddadhumaruk P,Arnold RM,White DB

    更新日期:2015-03-01 00:00:00

  • Evaluation of Institutional Review Board review and informed consent in publications of human research in critical care medicine.

    abstract:OBJECTIVE:To examine the frequency of obtaining Institutional Review Board (IRB) approval and informed consent in critical care research. DATA SOURCES AND DATA EXTRACTION:One-year retrospective review of original critical care research in humans published in seven journals, including American Journal of Respiratory an...

    journal_title:Critical care medicine

    pub_type: 杂志文章


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    更新日期:1998-09-01 00:00:00

  • Accuracy of intramucosal pH calculated from arterial bicarbonate and the Henderson-Hasselbalch equation: assessment using simulated ischemia.

    abstract:OBJECTIVES:To determine the accuracy of intramucosal pH (pHi) calculated using arterial bicarbonate instead of mucosal capillary bicarbonate in the Henderson-Hasselbalch equation. DESIGN:Simulation of progressive ischemia in mucosal capillary blood. SETTING:University research laboratory. SUBJECTS:Normal human blood...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Morgan TJ,Venkatesh B,Endre ZH

    更新日期:1999-11-01 00:00:00

  • Granulocyte colony-stimulating factor improves survival rate and reduces concentrations of bacteria, endotoxin, tumor necrosis factor, and endothelin-1 in fulminant intra-abdominal sepsis in rats.

    abstract:OBJECTIVE:To study the therapeutic effect of granulocyte colony-stimulating factor (G-CSF) on the mortality rate and host defense pattern in fulminant intra-abdominal sepsis. DESIGN:Prospective, randomized, controlled trial. SETTING:Research laboratory in a university hospital. SUBJECTS:Adult male Wistar rats. INTE...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lundblad R,Nesland JM,Giercksky KE

    更新日期:1996-05-01 00:00:00

  • Mechanical influences on the capnogram.

    abstract::We found that altering aspirating flow rate (ASR) and sample tubing length (STL) affected the response time and capnogram of 2 different side-stream capnometers. Increased flow rate shortened rise time, transit time, and total delay time (TDT), whereas increased STL increased transit and TDTs but not rise time. Increa...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schena J,Thompson J,Crone RK

    更新日期:1984-08-01 00:00:00

  • Education of trainees in the intensive care unit.

    abstract::The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Croley WC,Rothenberg DM

    更新日期:2007-02-01 00:00:00

  • Premedication for tracheal intubation: a prospective survey in 75 neonatal and pediatric intensive care units.

    abstract:OBJECTIVE:In children, like in adults, tracheal intubation is a painful procedure that may induce hypertension, tachycardia, and other undesirable hemodynamic disorders. Although premature neonates are very sensitive to pain and vulnerable to its long-term effects, the need for sedation before tracheal intubation is st...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Simon L,Trifa M,Mokhtari M,Hamza J,Treluyer JM

    更新日期:2004-02-01 00:00:00

  • Protecting healthcare workers from pandemic influenza: N95 or surgical masks?

    abstract:OBJECTIVE:The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infecti...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Gralton J,McLaws ML

    更新日期:2010-02-01 00:00:00

  • Neuroprotective effects of argon in an in vivo model of transient middle cerebral artery occlusion in rats.

    abstract:OBJECTIVE:The neuroprotective effects of the noble gas xenon are well known. Argon, in contrast to xenon, is abundant, inexpensive, and therefore widely applicable. In this study, we analyzed the possible neuroprotective role of argon in an in vivo rat model of acute focal cerebral ischemia. DESIGN:Controlled laborato...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Ryang YM,Fahlenkamp AV,Rossaint R,Wesp D,Loetscher PD,Beyer C,Coburn M

    更新日期:2011-06-01 00:00:00

  • Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.

    abstract:OBJECTIVE:To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. DESIGN:Observational, prospective, multiple-center study. SETTING:Four university hospitals and seven...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Garrouste-Orgeas M,Montuclard L,Timsit JF,Reignier J,Desmettre T,Karoubi P,Moreau D,Montesino L,Duguet A,Boussat S,Ede C,Monseau Y,Paule T,Misset B,Carlet J,French ADMISSIONREA Study Group.

    更新日期:2005-04-01 00:00:00

  • Carbon monoxide-dependent signaling.

    abstract::It has become accepted that nitric oxide serves important functions in biological systems as a second messenger. Another diatomic gaseous molecule, carbon monoxide (CO), is also rapidly gaining acceptance as a signaling agent. Some of the activities of CO are analogous to those of nitric oxide in the vascular system a...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Morse D,Sethi J,Choi AM

    更新日期:2001-01-01 00:00:00

  • Characteristics and Outcomes of HIV-Infected Patients With Severe Sepsis: Continued Risk in the Post-Highly Active Antiretroviral Therapy Era.

    abstract:OBJECTIVES:Although highly active antiretroviral therapy has led to improved survival in HIV-infected individuals, outcomes for HIV-infected patients with sepsis in the post-highly active antiretroviral therapy era are conflicting. Access to highly active antiretroviral therapy and healthcare disparities continue to af...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Cribbs SK,Tse C,Andrews J,Shenvi N,Martin GS

    更新日期:2015-08-01 00:00:00

  • Withdrawal and withholding of life support in the intensive care unit: a comparison of teaching and community hospitals. The Southwestern Ontario Critical Care Research Network.

    abstract:OBJECTIVES:To compare the incidence of withdrawal or withholding of life support (WD/WHLS), and to identify similarities and differences in the process of the withdrawal of life support (WDLS) between teaching and community hospitals' intensive care units (ICUs). DESIGN:Prospective cohort study, with some data obtaine...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Keenan SP,Busche KD,Chen LM,Esmail R,Inman KJ,Sibbald WJ

    更新日期:1998-02-01 00:00:00

  • Prospectively validated prediction of physiologic variables and organ failure in septic patients: The Systemic Mediator Associated Response Test (SMART).

    abstract:OBJECTIVE:Conventional outcomes research provides only percentage risk of such end points as mortality rate, utilization of resources, and/or broad groupings of multiple organ system dysfunction. These prognostications generally are not applicable to individual patients. The purpose of the present study was to determin...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章


    authors: Slotman GJ

    更新日期:2002-05-01 00:00:00

  • External Corroboration That Corticosteroids May Be Harmful to Septic Shock Endotype A Patients.

    abstract:OBJECTIVES:We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested th...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wong HR,Hart KW,Lindsell CJ,Sweeney TE

    更新日期:2021-01-01 00:00:00

  • Acute respiratory distress syndrome: frequency, clinical course, and costs of care.

    abstract:OBJECTIVE:To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care. DESIGN:A 3-yr (199...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Valta P,Uusaro A,Nunes S,Ruokonen E,Takala J

    更新日期:1999-11-01 00:00:00

  • Exosomes in Critical Illness.

    abstract:OBJECTIVE:Exosomes are small, cell-released vesicles (40-100 nm in size) with the potential to transfer proteins, lipids, small RNAs, messenger RNAs, or DNA between cells via interstitial fluids. Due to their role in tissue homeostasis, exosomes have emerged as a new type of therapeutic and diagnostic (theranostic) too...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Terrasini N,Lionetti V

    更新日期:2017-06-01 00:00:00

  • Comparative scintigraphy in oleic acid pulmonary microvascular injury.

    abstract::Computerized gamma scintigraphy revealed a significant (p less than 0.001) rising lung:heart radioactivity ratio, which has been called "slope of injury" or "slope index", with both 99mTechnetium-tagged human serum albumin (99mTc-HSA) and 99mTechnetium-tagged red blood cells (99Tc-RBC) after 0.05 or 0.2 ml/kg iv oleic...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Sugerman HJ,Hirsch JI,Tatum JL,Strash AM,Sharp DE,Greenfield LJ

    更新日期:1982-01-01 00:00:00

  • Use of Doppler ultrasound in performing percutaneous cannulation of the radial artery.

    abstract::Doppler ultrasound has been used extensively in assessing adequacy of circulation. We have found it to be convenient in the identification of blood flow, particularly in hypotensive states where percutaneous radial artery cannulation of the vessel is tedious and difficult to perform. The technique is simple, atraumati...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Nagabhushan S,Colella JJ Jr,Wagner R

    更新日期:1976-11-01 00:00:00

  • Impact of impedance threshold devices on cardiopulmonary resuscitation: a systematic review and meta-analysis of randomized controlled studies.

    abstract:OBJECTIVES:Vital organ hypoperfusion significantly contributes to the dismal survival rates observed with manual cardiopulmonary resuscitation after cardiac arrest. The impedance threshold device is a valve which reduces air entry into lungs during chest recoil between chest compressions, producing a potentially benefi...

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析


    authors: Cabrini L,Beccaria P,Landoni G,Biondi-Zoccai GG,Sheiban I,Cristofolini M,Fochi O,Maj G,Zangrillo A

    更新日期:2008-05-01 00:00:00

  • Hypoxia-reoxygenation is as damaging as ischemia-reperfusion in the rat liver.

    abstract:OBJECTIVE:We hypothesized that the extent of injury and release of xanthine oxidase, an oxidant generator, into the circulation would be less in normal-flow hypoxia-reoxygenation than in equal duration no-flow ischemia-reperfusion. DESIGN:Randomized study. SETTING:University-based animal research facility. SUBJECTS:...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Tan S,Yokoyama Y,Wang Z,Zhou F,Nielsen V,Murdoch AD,Adams C,Parks DA

    更新日期:1998-06-01 00:00:00

  • Brain death in pediatric intensive care unit patients: incidence, primary diagnosis, and the clinical occurrence of Turner's triad.

    abstract:OBJECTIVES:To determine the incidence and characteristics of children with brain death in the pediatric intensive care unit (ICU), and to assess the incidence of the clinical triad (Turner's triad) of central diabetes insipidus, low glucose demand, and low CO2 production. DESIGN:Retrospective review of medical records...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Staworn D,Lewison L,Marks J,Turner G,Levin D

    更新日期:1994-08-01 00:00:00

  • Ventricular function in myocardial contusion: a preliminary study.

    abstract::During a consecutive 17 month period, 15 trauma patients were diagnosed as having a myocardial contusion on the basis of abnormal ECG in 14 patients, elevated creatinine phosphokinase (CPK) in 13 patients, and elevated CPK-Muscle Brain (CPK-MB) isoenzyme determination in 11 patients. Using these screening modalities, ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Torres-Mirabal P,Gruenberg JC,Talbert JG,Brown RS

    更新日期:1982-01-01 00:00:00

  • Resolution of pneumothorax in neonates.

    abstract::The resolution time of pneumothorax in neonates requiring tube thoracotomy is not known. We found that 28%, 50%, and 83% of 54 pneumothoraces in 40 neonates resolved within 24, 96, and 168 h of tube thoracotomy, respectively. Pneumothoraces that persisted beyond 168 h were in infants requiring ventilatory assistance. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Bhatia J,Mathew OP

    更新日期:1985-05-01 00:00:00

  • Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation.

    abstract:OBJECTIVE:To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. DESIGN:Retrospective analysis of 49 consecutive patient...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Martin UJ,Hincapie L,Nimchuk M,Gaughan J,Criner GJ

    更新日期:2005-10-01 00:00:00