Immunology In Intensive Care Medicine 2007

The critical care community is challenged on a day to day basis by the increasing complexity of managing patients who have sepsis, shock, severe trauma or major operations. Numerous reviews focus on the basic science of immunity in abovementioned states, and various reviews concentrate on the clinical management of patients with these critical injuries that lead to altered immunity. The purpose of this book is to delineate the current understanding of the immune response to critical injury on the one hand, and lay a foundation on which we can understand and apply therapeutic advances in the management of this altered immunity on the other hand. Models of critical injuries have been successfully used to unravel the pathophysiologic processes during sepsis shock, severe trauma or major operations. Though basic research revealed several promising immunomodulating agents for the treatment of sepsis, such as neutralizing antibodies against the various inflammatory mediators involved in the exaggerated immune response during sepsis, most clinical trials evaluating the efficacy of these new immunomodulating agents in septic patients showed disappointing results. Why is it that these new innovative strategies did not work in the clinical arena while they proved to be very effective in the laboratory? In chapter 1 the several explanations for this discrepancy are discussed. The lungs of critically ill patients are at a constant threat of diverse inflammatory reactions. First, critically ill patients may develop acute lung injury or the acute respiratory distress syndrome, which can be the result of either a pulmonary insult, like pneumonia or direct trauma, or an indirect insult, such as sepsis or shock. Although frequently mandatory and life saving, mechanical ventilation puts patients at additional risks for secondary pulmonary inflammatory processes. Indeed, mechanically ventilated patients are prone to pneumonia (so called ventilator associated pneumonia), causing substantial additional morbidity and mortality. But mechanical ventilation may aggravate pulmonary inflammation (so called ventilator associated lung injury), which leads to a decreased change of survival. Recent reports even suggest that mechanical ventilation may initiate lung injury by itself. Mechanical ventilation may also contribute to the development of multiple organ failure. Causative immunological mechanisms include the concept suppression of peripheral immune responses, suggesting several potential therapeutic approaches. In chapter 2 the concepts of biotrauma, and loss of compartmentalization with mechanical ventilation are discussed. The proposed mechanisms linking mechanical ventilation to multiple organ failure suggest several novel therapeutic approaches. Severe systemic inflammatory response are almost invariably associated with disturbances in the blood clotting system, leading to the establishment of a procoagulant milieu. It is increasingly recognized that inflammation induced coagulation is not only encountered in the systemic circulation, but also on a local level, i.e. in the organs. Indeed, lung injury eliciting pulmonary inflammation is also characterized by a disturbed haemostatic balance, however mainly restricted to the bronchoalveolar compartment. Disturbances in pulmonary coagulopathy are discussed with regard to sepsis and lung injury in chapter 3. Adequate and timely detection of pulmonary inflammatory processes is severely hampered in clinical practice. Indeed, clinical manifestations of acute lung injury or the acute respiratory distress syndrome include rapid onset of bilateral chest radiographic consolidations consistent with edema and critical hypoxemia these clinical criteria, however, are at times hard to recognize. Similar diagnostic problems apply for the diagnosis of pneumonia in mechanically ventilated patients. In addition, neither chest radiograph findings nor clinical parameters can be used to monitor the effects of mechanical ventilation (i.e., the development of ventilator associated lung injury) in individual patients. A role for several types of biological markers for pulmonary injury in critically ill patients can be suggested. These include proteins that detect damage to the alveolar epithelium and pulmonary endothelium or increased permeability of the air blood barrier as well as recently discovered biological markers of infection. Examples of such biological markers are discussed in chapter 4. Corticosteroids were introduced in the treatment of severe infection mid last century. Several randomized controlled trials of high dose corticosteroids given for a short period of time in the early course of severe sepsis or acute respiratory distress syndrome did not show benefit. The link between septic shock and adrenal insufficiency and systemic inflammation induced corticoid receptor resistance prompted renewed interest of a replacement therapy with low doses of corticosteroids during longer periods. The key role of corticosteroids in the host response to critical injury is reviewed in chapter 5. In this chapter new validated indications of corticosteroids treatment in the ICU are presented. Toll like receptors are essential in the host defense against microorganisms they are the first to detect host invasion by pathogens, and initiate immune responses. Toll like receptors form the crucial link between the innate and adaptive immune systems. Chapter 6 focuses on the new insights in the pathogenesis of sepsis that is offered by the discovery of the Toll like receptors and its possible implications for intensive care medicine. Manipulation of the Toll like receptor pathway has great therapeutic potential the first clinical trials that evaluate the use of Toll like receptor modulating drugs in sepsis are being performed. Endothelial cells participate in many homeostatic processes, including control of vasomotor tone, trafficking of cells and nutrients, maintenance of blood fluidity, and regulation of permeability. During critical injury endothelial cells can be viewed as both a victim as well as a perpetrator of the inflammatory response. Chapter 7 summarizes endothelial physiology and pathophysiology and discusses both endothelial injury as well as the role of the endothelium in orchestrating the host response during injury, specifically sepsis. The potential value of the endothelium as a target for future therapy is discussed. Chapter 8 deals with one of these therapeutic options that influence endothelial activation and function. Intensive insulin therapy aiming at strict regulation of glucose concentration in critically ill patients, has gained much interest in recent years in view of its beneficial effects on morbidity and mortality. Intensive insulin therapy has been shown to reduce endothelial activation and end-organ dysfunction in patients with prolonged critical illness, but also affects the inflammatory process itself by anti-inflammatory effects, the preservation of mitochondrial ultrastructure, and maintaining cellular integrity.

The Yearbook compiles the most recent developments in experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

Our immune system is equipped with a series of defence mechanisms to recognise and respond to non-self molecules. Although essential for fighting off infections and preventing cancers, destructive immune responses pose a considerable challenge in autoinflammation and transplantation. Currently available immunosuppressants help to control destructive immune responses. However, management of side-effects of lifelong immunosuppression, including cancer development and reduced survival, remain major problems. For this reason, an increasing amount of interest is directed towards the natural specific regulatory mechanism of the immune system. A better understanding of these mechanisms holds the key. This book presents a comprehensive overview of immune suppression in transplantation, cancer and viral infections. Chapters cover modulation of Treg as well as the new era of immunotherapy.

Nutrition and infection are often at a crossroads, interacting with each other and influencing human health. Infection is a major health problem and nutritional deficiency plays a significant role in increasing the risk of infection. Nutrition–Infection Interactions and Impacts on Human Health presents state-of-the-art evidence on nutrition–infection interactions and their impact on health and disease. The book explores a wide range of topics including the effects of infection on nutrition—a common occurrence in the developing world—and nutrient–infection interactions for specific infections including HIV, TB, malaria, and parasitic infections. These are reviewed with a special emphasis on nutritional interventions. Also covered is the role of the gastrointestinal tract and its influence on nutrition, focusing on the human gastrointestinal microbiota, enteric syndromes, probiotics, and immunonutrients. The book discusses infection–nutrition interactions in special age groups such as children, adolescents, and the elderly. It also reviews emerging nutritional and anti-infective strategies with an emphasis on future research directions. The book is useful for epidemiologists, nutritionists, and health care staff caring for patients. The book’s broad scope allows for its applicability to both the developed and the developing world.

Aimed at all nurses, this key textbook equips them with the knowledge and skills required to care for the deteriorating patient in the clinical environment. The assessment, recognition and rapid escalation of the deteriorating patient is emphasized throughout the book. Using a unique system-based approach, each chapter contains structured learning outcomes and concludes with a competence-based skills assessment, which can be used to assess practice skills. These skills are recommended as essential for every nurse in an acute area and key to successful practice. Using real life case studies to link knowledge to actual practice and written by senior nurses for nurses, this book is an essential purchase for all nurses who work in acute care settings.

Comprehensive Toxicology, Third Edition, Fifteen Volume Set discusses chemical effects on biological systems, with a focus on understanding the mechanisms by which chemicals induce adverse health effects. Organized by organ system, this comprehensive reference work addresses the toxicological effects of chemicals on the immune system, the hematopoietic system, cardiovascular system, respiratory system, hepatic toxicology, renal toxicology, gastrointestinal toxicology, reproductive and endocrine toxicology, neuro and behavioral toxicology, developmental toxicology and carcinogenesis, also including critical sections that cover the general principles of toxicology, cellular and molecular toxicology, biotransformation and toxicology testing and evaluation. Each section is examined in state-of-the-art chapters written by domain experts, providing key information to support the investigations of researchers across the medical, veterinary, food, environment and chemical research industries, and national and international regulatory agencies. Thoroughly revised and expanded to 15 volumes that include the latest advances in research, and uniquely organized by organ system for ease of reference and diagnosis, this new edition is an essential reference for researchers of toxicology. Organized to cover both the fundamental principles of toxicology and unique aspects of major organ systems Thoroughly revised to include the latest advances in the toxicological effects of chemicals on the immune system Features additional coverage throughout and a new volume on toxicology of the hematopoietic system Presents in-depth, comprehensive coverage from an international author base of domain experts

This book published in two volumes. Both volume divided in twenty three sections, all sections and chapters are most important. The Textbook of Pulmonary and Critical Care Medicine also offers a unique exposure to the problems in many parts of the world. Tuberculosis, the “number one” treatable condition has been extensively covered; and special topics such as multi-drug resistance, directly observed therapy, TB prevention, nonpharmacologic approaches and extapulmonary tuberculosis are particularly relevant. Many countries are facing a growing burden of noncommunicable respiratory diseases. They have become the second leading cause of death after injuries, and their impact on indirect costs such as loss of work and home productivity is enormous. These problems are addressed and measures of prevention such as smoking cessation are included. Other special challenges including topics such as indoor and outdoor air pollution, climate change, poisoning with pesticides, snakebite toxicity, pulmonary manifestations of tropical infections and industrial accidents such as the tragedy seen in Bhopal, Madhya Pradesh, with methyl isocyanate, have been well covered. However, as globalization flattens the playing field, and countries leap to industrialization, cultural beliefs, natural resources, climate and geography have slowed the pace of development in many parts of the world. Poverty leads to malnutrition, homelessness, lack of education, and poor access to health care. Overcrowded cities and rural underdevelopment are other challenges that impact health in the various parts of the world. Moreover, epidemics of HIV, drug abuse and smoking addiction take a greater toll on the population. Yes, the world is flat, but the terrain is filled with mountains and valleys and local problems demand local solutions. And these local problems need to be explored and presented with a scholarly perspective. The Textbook of Pulmonary and Critical Care Medicine has successfully incorporated these sociodemographic factors into the subject matter. The text is well-written and the chapters are carefully referenced with subjects found in all traditional pulmonary and critical care textbooks, e.g. airway diseases, interstitial lung disease, pleural disease, pulmonary neoplasia, pulmonary infection, sleep and critical care. There are several nontraditional sections as well that are practical and especially helpful to the practicing physician. These include a section on the symptom approach to lung disease, an overview of the pharmacologic agents used to treat lung disease, and a comprehensive review of methods in lung diagnosis from the simple history and physical examination to the latest complex tools of interventional pulmonology. The textbook is especially unique because of the abundance of illustrations, flow charts and tables. There are many radiographic and pathologic reproductions that are especially helpful.

Stay up-to-date on the latest evidence and clinical practice in pediatric acute care with the definitive textbook in the field. Now in its second edition, Pediatric Acute Care: A Guide for Interprofessional Practice takes an evidence-based, interprofessional approach to pediatric acute care as it exemplifies the depth and diversity that’s needed for the dynamic healthcare environments in which acutely ill children receive care. Coverage includes how to work with the pediatric patient and family, major acute care disorders and their management, emergency preparedness, common acute care procedures, and much more. With contributions from more than 200 practicing clinicians and academic experts, it represents a wide variety of disciplines including medicine, nursing, pharmacy, child life, nutrition, law, integrative medicine, education, public health, and psychology, among others. The second edition also features the addition of new physician and nurse practitioner co-editors as well as extensive content updates including updated evidence-based content throughout the text, the integration of the 2016 IPEC Core Competencies for Interprofessional Collaborative Practice, a new full-color design, and new vivid illustrations throughout. UNIQUE! Interprofessional collaborative approach includes contributions from more than 200 practicing clinicians and academic experts from the U.S. and Canada, including nursing, medicine, pharmacy, child life, nutrition, law, integrative medicine, education, public health, and psychology. Consistent organization within disorder chapters begins with a section on Physiology and continues with sections on Pathophysiology, Epidemiology and Etiology, Presentation, Differential Diagnosis, Diagnostic Studies, and a Plan of Care that include Therapeutic Management, Consultation, Patient and Family Education and Disposition and Discharge Planning. Comprehensive content spanning five units divides coverage into introductory information, the approach to the pediatric patient and family, major acute care disorders and their management, emergency preparedness, and common acute care procedures. NEW! Updated evidence-based content has been added throughout to ensure that you’re up-to-date on all topics needed to provide care for pediatric patients in acute, inpatient, emergency, transport, and critical care settings. NEW! Full-color design and illustrations enhance learning and make content easier to navigate and digest. NEW! Integration of the 2016 IPEC Core Competencies ensure that you’re learning the professional skills and protocols required for effective, contemporary interprofessional collaborative practice. UPDATED! Streamlined procedures unit focuses more sharply on need-to-know content.