Abstract
Impaired host defense mechanisms following surgical stress such as burn, major surgery and polytrauma are considered important for the development of infectious complications and sepsis. We tested whether interferon (IFN) gamma can improve monocytic and lymphocytic functions and can reduce deaths related to sepsis. In order to restore their antimicrobial defense capacity, recombinant human IFN-gamma, 100 μg, was administered intravenously once daily to six immunoparalyzed patients. Informed consent was obtained from patients in all cases, and the study received local hospital ethical committee approval. Intracytoplasmic Th1 and Th2 cytokine production in isolated peripheral blood mononuclear cells was assessed by flow cytometry following in vitro activation by phorbol myristate acetate plus ionomycin. Monocytic human leukocyte antigen-DR (HLA-DR) expression was also measured. Immunoparalysis was defined as a decreased level of HLA-DR expression of monocytes <30% or a decreased level of Th1 <10%. IFN-gamma applied to immunoparalytic patients with low monocytic HLA-DR expression restored the deficient HLA-DR expression and in vitro Th1 cytokine production completely within 3 days. Recovery from immunoparalysis resulted in clearance of sepsis in four of six patients. IFN-gamma administration in septic patients accompanied with immunoparalysis is a new therapeutic strategy. Table 1
Highlights
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today
Summary Our study demonstrated that LS is a good alternative to restore cardiac contractile function when combined with NE
The use of AVP may lead to further deteriorate sepsis-related myocardial dysfunction even when combined with a positive inotropic agent
Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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