Management of Dysregulated Immune Response in the Critically Ill

Description:

This book, part of the European Society of Intensive Care Medicine (ESICM) textbook series, deals with dysregulated host response a relatively new term introduced by the Sepsis-3 definitions in 2016. In contrast to systemic inflammatory response syndrome (SIRS) that has been used for nearly 30 years, this is a fundamentally new concept, which requires some sort of a paradigm shift in the way of thinking of critical care physicians. This change obviously requires time and after 5 years, time is ripe to summarize the knowledge in the form of a comprehensive book.

The book is split in 4 sections. In the first one, the host immune response is explained in 11 chapters, followed by the next part, summarizing the possible tools for assessment at the bedside. The third and the fourth parts focus on the effects of dysregulated immune response on vital organ function and on the possible ways of immunomodulation. Written by internationally acclaimed experts of the field, the book is of value for all those intensivists and allied professionals working in ICUs.

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Table of contents :
Foreword
Preface
Contents
Contributors
I: The Host Immune Response
1: Phenotypes
1.1 Introduction: The Critically Ill, a Heterogeneous Population
1.2 Subphenotypes Identified in Critically Ill Patients
1.2.1 Sepsis
1.2.2 Acute Respiratory Distress Syndrome
1.2.3 Acute Kidney Injury
1.2.4 Implications of Identified Subphenotypes
1.3 The Immune Response in Subphenotypes
1.3.1 Innate Immune Response
1.3.2 Adaptive Immune Response
1.3.3 Implications of the Immune Response in Subphenotypes
1.3.4 Unique or Generalizable?
1.4 Future Challenges
References
2: The Dysregulated Host Response
2.1 Introduction
2.2 The Inflammatory Response in Severe Infection
2.3 The Immune Depression in Sepsis (Early and Late Phase)
2.3.1 The Immune Phases
2.3.2 The “Downregulation” of Monocyte/Macrophages
2.3.3 The Immunodepression and Adaptive Immunity
2.3.4 The Proteomic Consequences
2.4 The Role of Cellular Metabolism
2.4.1 The Aerobic Glycolysis or “Warburg Effect” (. Fig. 2.2 [57])
2.4.2 The Hypoxia-Inducible Factor (HIF)
2.4.3 The Regulation of the Immune Response by mTOR [68] 2.4.4 The Combination of Mediated mTOR and HIF-1α Aerobic Glycolysis: A Basis for Trained Immunity [3, 5] (. Fig. 2.4)
2.4.5 The Liaison Between Metabolic Shift Modifications and Functions of Immune Cells
Conclusion and Road Map for the Future
References
3: What Is Cytokine Storm?
3.1 Introduction
3.2 Pathophysiology of CS
3.3 Inflammation Due to Sepsis
3.4 Hypercytokinemia in Sepsis
3.5 Hypercytokinemia in Post-cardiac Arrest Syndrome
3.6 Endotoxin-Induced CS
3.7 CS After Splenectomy
3.8 Invasive Meningococcal Disease (IMD)
3.9 COVID-19
3.10 Iatrogenic CS
3.11 After the Storm
3.12 Summary
References
4: Hemophagocytic Lymphohistiocytosis
4.1 Introduction
4.2 Types
4.3 Epidemiology
4.4 Triggers and Underlying Conditions
4.5 Pathobiology
4.6 Clinical Presentation
4.7 Diagnosis
4.8 Treatment
4.9 Macrophage activation syndrome (MAS-HLH)
4.10 HLH and Sepsis
4.11 Prognosis
4.12 Summary
References
5: Extracorporeal Circulation-Related Immune Response
5.1 Introduction
5.2 Extracorporeal Circulations in ICU Practice
5.2.1 Renal Replacement Therapy
5.2.2 ECMO
5.3 Extracorporeal Circulation-Related Immune Response and the Clinical Implications
5.3.1 Contact and Complement System
Contact System
Complement System
5.3.2 Inflammatory Cytokine and Chemokine Response
5.3.3 Leukocytes
Impact on the Innate Immune Leukocytes: Neutrophils and Monocytes
Impact on Neutrophil Phenotype and Function
Impact on Monocyte Phenotype and Function
Impact on the Adaptive Immune Leukocytes: T and B Lymphocytes
Impact on T and B Lymphocyte Phenotype and Function
5.4 Causes of Extracorporeal Circulation-Related Immune Response
5.4.1 RRT and ECMO Technology (ECC Circuit Designs and Materials)
Blood Pumps
Membranes
RRT Filter Membranes
ECMO Membrane Oxygenator
5.4.2 Non-physiological Conditions
5.5 Priorities for Future Research: Potential Therapeutic Interventions in ECC-Associated Immune Response
5.5.1 Knowing the Technological Disparities
5.5.2 Understanding Factors Contributing to RRT- and  ECMO-Related Immune Modulation
5.5.3 Potential Interventions and Targets for RRT- and  ECMO-Related Immune Modulation
References
6: Septic Shock

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