Molecular biology of inflammation and sepsis: a primer.


BACKGROUND:Remarkable progress has been made during the last decade in defining the molecular mechanisms that underlie septic shock. This rapidly expanding field is leading to new therapeutic opportunities in the management of severe sepsis. AIM:To provide the clinician with a timely summary of the molecular biology of sepsis and to better understand recent advances in sepsis research. DATA SELECTION:Medline search of relevant publications in basic mechanisms of sepsis/severe sepsis/septic shock, and selected literature review of other manuscripts about the signalosome, inflammasome, apoptosis, or mechanisms of shock. DATA SYNTHESIS AND FINDINGS: The identification of the toll-like receptors and the associated concept of innate immunity based upon pathogen- or damage-associated molecular pattern molecules allowed significant advances in our understanding of the pathophysiology of sepsis. The essential elements of the inflammasome and signal transduction networks responsible for activation of the host response have now been characterized. Apoptosis, mitochondrial dysfunction, sepsis-related immunosuppression, late mediators of systemic inflammation, control mechanisms for coagulation, and reprogramming of immune response genes all have critical roles in the development of sepsis. CONCLUSIONS:Many of these basic discoveries have direct implications for the clinical management of sepsis. The translation of these "bench-to-bedside" findings into new therapeutic strategies is already underway. This brief review provides the clinician with a primer into the basic mechanisms responsible for the molecular biology of sepsis, severe sepsis, and septic shock.


Crit Care Med


Critical care medicine


Cinel I,Opal SM




Has Abstract


2009-01-01 00:00:00












  • Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure.

    abstract:OBJECTIVE:To determine whether continuous modes of renal replacement therapy result in improved cardiovascular stability compared with standard daily intermittent treatment in critically ill patients. DESIGN:Prospective, randomized controlled trial. SETTING:Intensive care unit in a quaternary referral center for live...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Davenport A,Will EJ,Davidson AM

    更新日期:1993-03-01 00:00:00

  • Continuous Versus Intermittent Infusion of Vancomycin and the Risk of Acute Kidney Injury in Critically Ill Adults: A Systematic Review and Meta-Analysis.

    abstract:OBJECTIVES:Critically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investi...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Flannery AH,Bissell BD,Bastin MT,Morris PE,Neyra JA

    更新日期:2020-06-01 00:00:00

  • Spontaneous gasping increases the ability to resuscitate during experimental cardiopulmonary resuscitation.

    abstract:OBJECTIVE:To evaluate the effect of spontaneous gasping on cardiorespiratory functions and the ability to resuscitate during experimental cardiac arrest. DATA SOURCES:Studies in rat and pig models during cardiac arrest and cardiopulmonary resuscitation (CPR). STUDY SELECTION:We retrospectively examined the role of sp...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Yang L,Weil MH,Noc M,Tang W,Turner T,Gazmuri RJ

    更新日期:1994-05-01 00:00:00

  • Ventilator-Associated Events: Prevalence, Outcome, and Relationship With Ventilator-Associated Pneumonia.

    abstract:OBJECTIVES:Centers for Disease Control and Prevention built up new surveillance paradigms for the patients on mechanical ventilation and the ventilator-associated events, comprising ventilator-associated conditions and infection-related ventilator-associated complications. We assess 1) the current epidemiology of venti...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Bouadma L,Sonneville R,Garrouste-Orgeas M,Darmon M,Souweine B,Voiriot G,Kallel H,Schwebel C,Goldgran-Toledano D,Dumenil AS,Argaud L,Ruckly S,Jamali S,Planquette B,Adrie C,Lucet JC,Azoulay E,Timsit JF,OUTCOMEREA Study

    更新日期:2015-09-01 00:00:00

  • Can we prevent the spread of focal lung inflammation?

    abstract::By definition, the acute respiratory distress syndrome is associated with diffuse cellular infiltration and proteinaceous edema. It is generally believed that the widespread injury that characterizes acute respiratory distress syndrome is a process that is launched almost synchronously throughout the lung, caused by b...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Marini JJ

    更新日期:2010-10-01 00:00:00

  • Noise Levels in Surgical ICUs Are Consistently Above Recommended Standards.

    abstract:OBJECTIVE:The equipment, monitor alarms, and acuity of patients in ICUs make it one of the loudest patient care areas in a hospital. Increased sound levels may contribute to worsened outcomes in these particularly vulnerable patients. Our objective was to determine whether ambient sound levels in surgical ICUs comply w...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Tainter CR,Levine AR,Quraishi SA,Butterly AD,Stahl DL,Eikermann M,Kaafarani HM,Lee J

    更新日期:2016-01-01 00:00:00

  • Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients.

    abstract:OBJECTIVE:Therapeutic hypothermia has been used to attenuate the effects of traumatic brain injuries. However, the required degree of hypothermia, length of its use, and its timing are uncertain. We undertook a comprehensive meta-analysis to quantify benefits of hypothermia therapy for traumatic brain injuries in adult...

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析,评审


    authors: Crompton EM,Lubomirova I,Cotlarciuc I,Han TS,Sharma SD,Sharma P

    更新日期:2017-04-01 00:00:00

  • Observational Research for Therapies Titrated to Effect and Associated With Severity of Illness: Misleading Results From Commonly Used Statistical Methods.

    abstract:OBJECTIVES:In critically ill patients, treatment dose or intensity is often related to severity of illness and mortality risk, whereas overtreatment or undertreatment (relative to the individual need) may further increase the odds of death. We aimed to investigate how these relationships affect the results of common st...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: de Grooth HJ,Girbes ARJ,van der Ven F,Oudemans-van Straaten HM,Tuinman PR,de Man AME

    更新日期:2020-12-01 00:00:00

  • Lipid peroxidation in experimental septic rats.

    abstract::We previously reported increased lipid peroxide and decreased alpha-tocopherol levels in the blood of critically ill septic patients. To clarify these results, we investigated lipid peroxidation in experimental septic rats and severely traumatized rats. In septic rats, both platelet count and plasma alpha-tocopherol d...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Takeda K,Shimada Y,Okada T,Amano M,Sakai T,Yoshiya I

    更新日期:1986-08-01 00:00:00

  • Levosimendan is superior to milrinone and dobutamine in selectively increasing microvascular gastric mucosal oxygenation in dogs.

    abstract:OBJECTIVE:The effect of levosimendan, a novel inotropic vasodilator (inodilator), on the microvascular gastric mucosal hemoglobin oxygenation (muHbo(2)) is unknown. A possible effect could thereby be selective for the splanchnic region or could primarily reflect changes in systemic oxygen transport (Do(2)) and/or oxyge...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schwarte LA,Picker O,Bornstein SR,Fournell A,Scheeren TW

    更新日期:2005-01-01 00:00:00

  • Guide to ethical decision-making for the critically ill: the three R's and Q.C.

    abstract::Ethical decision-making for the care of the critically ill and injured has never been more difficult than it is today. Major technologic advances prolong life but often provide questionable benefit in human terms. Both the ethical commitment to the individual patient and the competition for access to expensive and sca...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Weil MH,Weil CJ,Rackow EC

    更新日期:1988-06-01 00:00:00

  • Evidence based critical care medicine; what is it and what can it do for us? Evidence Based Medicine in Critical Care Group.

    abstract:OBJECTIVE:To describe the philosophy and approach to patient care called evidence based medicine, and to highlight how it can enhance the practice of intensive care. DATA SOURCES:We searched MEDLINE, reference lists, and our personal files to identify relevant literature. STUDY SELECTION:Articles on intensive care pr...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Cook DJ,Sibbald WJ,Vincent JL,Cerra FB

    更新日期:1996-02-01 00:00:00

  • Acute oxygenation response to inhaled nitric oxide when combined with high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome.

    abstract:OBJECTIVE:To prospectively evaluate the oxygenation effect of inhaled nitric oxide (INO) delivered during high-frequency oscillatory ventilation in adult patients with the acute respiratory distress syndrome and oxygenation failure. DESIGN Prospective, clinical study. SETTING:Intensive care unit of a university teachi...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Mehta S,MacDonald R,Hallett DC,Lapinsky SE,Aubin M,Stewart TE

    更新日期:2003-02-01 00:00:00

  • Effects of Different Doses of Remote Ischemic Preconditioning on Kidney Damage Among Patients Undergoing Cardiac Surgery: A Single-Center Mechanistic Randomized Controlled Trial.

    abstract:OBJECTIVES:We have previously shown that remote ischemic preconditioning reduces acute kidney injury (acute kidney injury) in high-risk patients undergoing cardiopulmonary bypass and that the protective effect is confined to patients who exhibit an increased urinary tissue inhibitor of metalloproteinases-2 and insulin-...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Meersch M,Küllmar M,Pavenstädt H,Rossaint J,Kellum JA,Martens S,Klausmeyer P,Schmidt EA,Kerschke L,Zarbock A

    更新日期:2020-08-01 00:00:00

  • A randomized, controlled trial of computerized physiologic trend monitoring in an intensive care unit.

    abstract:OBJECTIVE:To assess whether the provision of computerized physiologic trend data could improve outcome in newborn infants requiring intensive care. DESIGN:Randomized, controlled trial, with subsidiary questionnaire studies. SETTING:Tertiary neonatal intensive care unit with 12 intensive care cots. PATIENTS:All infan...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Cunningham S,Deere S,Symon A,Elton RA,McIntosh N

    更新日期:1998-12-01 00:00:00

  • Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis.

    abstract:OBJECTIVES:A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Meyer N,Harhay MO,Small DS,Prescott HC,Bowles KH,Gaieski DF,Mikkelsen ME

    更新日期:2018-03-01 00:00:00

  • The hepatoadrenal syndrome: a common yet unrecognized clinical condition.

    abstract:OBJECTIVE:Adrenal failure is common in critically ill patients, particularly those with sepsis. As liver failure and sepsis are both associated with increased circulating levels of endotoxin and proinflammatory mediators and reduced levels of apoprotein-1/high-density lipoprotein, we postulated that adrenal failure may...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Marik PE,Gayowski T,Starzl TE,Hepatic Cortisol Research and Adrenal Pathophysiology Study Group.

    更新日期:2005-06-01 00:00:00

  • Nosocomial Infection.

    abstract:OBJECTIVE:The first 70 years of critical care can be considered a period of "industrial revolution-like" advancement in terms of progressing the understanding and care of critical illness. Unfortunately, like the industrial revolution's impact on the environment, advancing ICU care of increasingly elderly, immunosuppre...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Kollef MH,Torres A,Shorr AF,Martin-Loeches I,Micek ST

    更新日期:2021-02-01 00:00:00

  • Sublingual capnometry versus traditional markers of tissue oxygenation in critically ill patients.

    abstract:OBJECTIVE:The purpose of this study was to determine the prognostic value of sublingual PCO2 (P(SL)CO2), lactate concentration, and mixed venous oxygen saturation (S(MV)O2) in hemodynamically unstable intensive care patients and, additionally, to compare the temporal changes of these variables in response to treatment....

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Marik PE,Bankov A

    更新日期:2003-03-01 00:00:00

  • Hyperchloremia Is Associated With Acute Kidney Injury in Patients With Subarachnoid Hemorrhage.

    abstract:OBJECTIVE:To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients. DESIGN:Retrospective analysis of all subarachnoid hemorrhage admissions. SETTINGS:Neurocritical care unit. PATIENTS:All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014. INTERVENTIO...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Sadan O,Singbartl K,Kandiah PA,Martin KS,Samuels OB

    更新日期:2017-08-01 00:00:00

  • Colonization with broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units during a nonoutbreak period: prevalence, risk factors, and rate of infection.

    abstract:OBJECTIVE:To define the epidemiology of broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units (ICUs) during a nonoutbreak period, including the prevalence, the risk factors for colonization, the frequency of acquisition, and the rate of infection. DESIGN:Prospective cohort study. SETTIN...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: D'Agata EM,Venkataraman L,DeGirolami P,Burke P,Eliopoulos GM,Karchmer AW,Samore MH

    更新日期:1999-06-01 00:00:00

  • Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital.

    abstract:OBJECTIVE:The benefit of continuous on-site presence by a staff academic critical care specialist in the intensive care unit of a teaching hospital is not known. We compared the quality of care and patient/family and provider satisfaction before and after changing the staffing model from on-demand to continuous 24-hr c...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章


    authors: Gajic O,Afessa B,Hanson AC,Krpata T,Yilmaz M,Mohamed SF,Rabatin JT,Evenson LK,Aksamit TR,Peters SG,Hubmayr RD,Wylam ME

    更新日期:2008-01-01 00:00:00

  • Mild hypothermia decreases arrhythmia susceptibility in a canine model of global myocardial ischemia*.

    abstract:OBJECTIVES:Although the majority of sudden cardiac arrests occur in patients with ischemic heart disease, the effect of therapeutic hypothermia on arrhythmia susceptibility during acute global ischemia is not well understood. While both ischemia and severe hypothermia are arrhythmogenic, patients undergoing therapeutic...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Piktel JS,Rosenbaum DS,Wilson LD

    更新日期:2012-11-01 00:00:00

  • Endotoxin increases plasma leptin and ghrelin levels in dogs.

    abstract:OBJECTIVE:Evaluations of plasma leptin and ghrelin levels and their relations with circulating levels of proinflammatory mediators, stress hormones, and biochemical markers of hepatorenal injury during experimental endotoxemia in dogs. SETTING:Uludag University. DESIGN:Placebo-controlled animal study. ANIMALS:Adult ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Yilmaz Z,Ilcol YO,Ulus IH

    更新日期:2008-03-01 00:00:00

  • Timing and predictors of death in pediatric patients with multiple organ system failure.

    abstract:OBJECTIVES:To describe the timing of onset of organ system failure, multiple organ system failure diagnosis, and the subsequent death in children admitted to a pediatric intensive care unit (ICU). Second, to identify independent risk markers of death in pediatric patients with multiple organ system failure. DESIGN:Rev...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Proulx F,Gauthier M,Nadeau D,Lacroix J,Farrell CA

    更新日期:1994-06-01 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

  • Risk factors predicting laryngeal injury in intubated neonates.

    abstract::We evaluated 95 extubated neonates to determine if certain risk factors could predict the development of laryngeal injury. Risk factors were recorded prospectively during the intubation period and correlated with laryngeal injury determined by laryngoscopy after extubation. Duration of intubation greater than or equal...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Fan LL,Flynn JW,Pathak DR

    更新日期:1983-06-01 00:00:00

  • Evaluation of a modified piezoresistive technique and a water-capsule technique for direct and continuous measurement of intra-abdominal pressure in a porcine model.

    abstract:OBJECTIVE:Intravesical pressure measurement is considered to be the gold standard for the assessment of intra-abdominal pressure. However, this method is indirect and depends on a physiologic bladder function. We evaluated a modified piezoresistive technique and a water-capsule technique for direct and continuous intra...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schachtrupp A,Henzler D,Orfao S,Schaefer W,Schwab R,Becker P,Schumpelick V

    更新日期:2006-03-01 00:00:00

  • Perceptions of Ethical Decision-Making Climate Among Clinicians Working in European and U.S. ICUs: Differences Between Nurses and Physicians.

    abstract:OBJECTIVES:To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothes...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Jensen HI,Hebsgaard S,Hansen TCB,Johnsen RFA,Hartog CS,Soultati I,Szucs O,Wilson ME,van den Bulcke B,Benoit DD,Piers R

    更新日期:2019-12-01 00:00:00

  • Attenuation of hyperoxia-induced diaphragmatic dysfunction with lidocaine in hamsters.

    abstract:OBJECTIVE:Toxic free radicals cause dysfunction of respiratory muscles, probably leading to respiratory distress. Exposure to high concentrations of oxygen generates plenty of free radicals. Lidocaine scavenges the reactive molecules. The purposes of the current study were first to examine whether hyperoxia impairs dia...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Nishina K,Mikawa K,Shiga M,Kodama S,Kagawa T,Maekawa N,Obara H

    更新日期:2000-06-01 00:00:00