Department of Internal Medicine, Bezirkskrankenhaus Hall in Tirol, 6060 Hall in Tirol, Austria.
Med Hypotheses. 2010 Jul;75(1):32-4. doi: 10.1016/j.mehy.2010.01.020. Epub 2010 Feb 6.
Despite successful intensive care a substantial portion of critically ill patients dies after discharge from the intensive care unit or hospital. Observational studies investigating long-term survival of critically ill patients reported that most deaths occur during the first months or year after discharge. Only limited data on the causes of impaired quality of life and post-intensive care unit deaths exist in the current literature. In this manuscript we hypothesize that the acute inflammatory response which characteristically accompanies critical illness is ensued by a prolonged imbalance or activation of the immune system. Such a chronic low-grade inflammatory response to critical illness may be sub-clinical and persist for a variable period of time after discharge from the intensive care unit and hospital. Chronic inflammation is a well-recognized risk factor for long-term morbidity and mortality, particularly from cardiovascular causes, and may thus partly contribute to the impaired quality of life as well as increased morbidity and mortality following intensive care unit and hospital discharge of critically ill patients. Assuming that critical illness is indeed followed by a prolonged inflammatory response, important implications for treatment would arise. An interesting and potentially beneficial therapy could be the administration of immune-modulating drugs during the time after intensive care unit or hospital discharge until chronic inflammation has subsided. Statins are well-investigated and effective drugs to attenuate chronic inflammation and could potentially also improve long-term outcome of critically ill patients after intensive care unit or hospital discharge. Future studies evaluating the course of inflammation during and after critical illness as well as its response to statin therapy are required.
尽管重症监护取得了成功，但仍有相当一部分重症患者在离开重症监护病房或医院后死亡。对重症患者长期生存情况进行观察研究的报告指出，大多数死亡发生在出院后第一个月或一年内。目前文献中仅有关于影响生活质量和重症监护病房后死亡的原因的有限数据。在本手稿中，我们假设急性炎症反应是伴随危重病而发生的，其特征是免疫系统的长期失衡或激活。这种慢性低度炎症反应可能是亚临床的，并在离开重症监护病房和医院后的一段时间内持续存在。慢性炎症是长期发病率和死亡率的公认危险因素，特别是心血管原因，因此可能部分导致重症患者离开重症监护病房和医院后生活质量下降以及发病率和死亡率增加。假设危重病确实会导致长期炎症反应，那么这将对治疗产生重要影响。一种有趣且可能有益的治疗方法可能是在离开重症监护病房或医院后使用免疫调节药物，直到慢性炎症消退。他汀类药物是经过充分研究的有效药物，可以减轻慢性炎症，并且可能还可以改善重症患者离开重症监护病房或医院后的长期预后。需要进一步研究评估重症期间和之后的炎症过程及其对他汀类药物治疗的反应。
