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Pro-inflammatory and Anti-inflammatory Mediators in Critical Illness and Injury

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Pediatric Critical Care Medicine

Abstract

Many forms of critical illness are characterized, at their onset, by a pro-inflammatory insult. Counter-regulatory, anti-inflammatory processes also exist in order to promote immunologic homeostasis. These processes are driven by, and modulate, the innate and adaptive arms of the immune system and are, in part, mediated by cytokines and chemokines. While surges in these pro-inflammatory mediators clearly produce many of the signs and symptoms of critical illness, the resultant anti-inflammatory surge has associated consequences as well. Systemic cytokine levels and leukocyte mRNA expression patterns suggest significant dysregulation of the inflammatory response in critical illness, though immune function testing is likely to be important as well. Severe reductions in innate and adaptive immune function following the onset of critical illness have been reported with increased risks for nosocomial infection and death across a wide array of adult and pediatric forms of critical illness. Immune monitoring and modulation trials are badly needed in the ICU, as growing evidence suggests that severe critical illness-induced immune suppression, or immunoparalysis, is reversible with potentially beneficial effects on outcomes. In addition, it appears that many of the therapies that are routinely used in critically ill children, including medications and transfusions, are likely to be inadvertently immunomodulatory. The role of these therapies, as well as the role of host genetics, on immunologic function and immunologic balance is poorly understood.

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Author information

Authors and Affiliations

  1. Division of Critical Care Medicine, The Ohio State University College of Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Jennifer A. Muszynski MD

  2. Division of Critical Care Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    W. Joshua Frazier MD & Mark W. Hall MD

Authors
  1. Jennifer A. Muszynski MD
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  2. W. Joshua Frazier MD
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  3. Mark W. Hall MD
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Corresponding author

Correspondence to Mark W. Hall MD .

Editor information

Editors and Affiliations

  1. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Muszynski, J.A., Frazier, W.J., Hall, M.W. (2014). Pro-inflammatory and Anti-inflammatory Mediators in Critical Illness and Injury. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6362-6_22

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  • DOI: https://doi.org/10.1007/978-1-4471-6362-6_22

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  • Online ISBN: 978-1-4471-6362-6

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