Immunostimulation in critically ill patients: do not forget to consider the timing, stratification, and monitoring

Excerpt

The paradigm of a primarily systemic inflammatory component during severe host aggression (sepsis, trauma, surgery, pancreatitis, and cirrhosis) has been abandoned in favor of a more nuanced view of the condition. Indeed, host injury is a more complex phenomenon involving a systemic, massive, and sometimes uncontrolled inflammatory response, along with an anti-inflammatory and sometimes immunosuppressive response aimed at modulating the initial inflammatory response. This phenomenon regulates the excessive immune response that may cause tissue damage [1]. The intensity of this bivalent response varies from patient to patient and, more importantly, evolves over time (at least in the first 3–4 days) [2]. As a result, the immuno-inflammatory trajectories of intensive care unit (ICU)high-rate patients are multidirectional, and any intervention aimed at modulating these trajectories (whether pro- or anti-inflammatory) should be considered from the perspective of precision medicine. …