scholarly journals Immunomonitoring of Monocyte and Neutrophil Function in Critically Ill Patients: From Sepsis and/or Trauma to COVID-19

2021 ◽  
Vol 10 (24) ◽  
pp. 5815
Author(s):  
Ivo Udovicic ◽  
Ivan Stanojevic ◽  
Dragan Djordjevic ◽  
Snjezana Zeba ◽  
Goran Rondovic ◽  
...  

Immune cells and mediators play a crucial role in the critical care setting but are understudied. This review explores the concept of sepsis and/or injury-induced immunosuppression and immuno-inflammatory response in COVID-19 and reiterates the need for more accurate functional immunomonitoring of monocyte and neutrophil function in these critically ill patients. in addition, the feasibility of circulating and cell-surface immune biomarkers as predictors of infection and/or outcome in critically ill patients is explored. It is clear that, for critically ill, one size does not fit all and that immune phenotyping of critically ill patients may allow the development of a more personalized approach with tailored immunotherapy for the specific patient. In addition, at this point in time, caution is advised regarding the quality of evidence of some COVID-19 studies in the literature.

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Geert Koster ◽  
Thomas Kaufmann ◽  
Bart Hiemstra ◽  
Renske Wiersema ◽  
Madelon E. Vos ◽  
...  

Abstract Background Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min−1 with limits of agreement of − 2.6 L min−1 to 2.7 L min−1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624


2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.


2016 ◽  
Vol 28 (10) ◽  
pp. 2915-2920
Author(s):  
José Marcelo e Souza Mafra ◽  
Janete Maria da Silva ◽  
Leda Tomiko Yamada da Silveira ◽  
Carolina Fu ◽  
Clarice Tanaka

2006 ◽  
Vol 32 (3) ◽  
pp. 167-170
Author(s):  
P. Sclauzero ◽  
S. Casarotto ◽  
M. Martingano ◽  
F. Morpurgo ◽  
I. Rocconi ◽  
...  

1996 ◽  
Vol 22 (10) ◽  
pp. 1034-1042 ◽  
Author(s):  
R. Rivera Fernandez ◽  
J. J. Sanchez Cruz ◽  
G. Vazquez Mata

Anaesthesia ◽  
1997 ◽  
Vol 52 (12) ◽  
pp. 1137-1143 ◽  
Author(s):  
J. Rogers ◽  
S. Ridley ◽  
P. Chrispin ◽  
H. Scotton ◽  
D. Lloyd

2020 ◽  
Vol 39 (4) ◽  
pp. 1146-1154 ◽  
Author(s):  
N.V. Margaritelis ◽  
V. Paschalis ◽  
A.A. Theodorou ◽  
V. Vassiliou ◽  
A. Kyparos ◽  
...  

2019 ◽  
Vol 40 (05) ◽  
pp. 571-579
Author(s):  
Mayanka Tickoo

AbstractIn the critically ill adult, dysglycemia is a marker of disease severity and is associated with worse clinical outcomes. Close monitoring of glucose and use of insulin in critically ill patients have been done for more than 2 decades, but the appropriate target glycemic range in critically ill patients remains controversial. Physiological stress response, levels of inflammatory cytokines, nutritional intake, and level of mobility affect glycemic control, and a more personalized approach to patients with dysglycemia is warranted in critically ill intensive care unit (ICU) patients. We discuss the pathophysiology and downstream effects of altered glycemic response in critical illness, management of glycemic control in the ICU, and future strategies toward personalization of critical care glycemic management.


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