Mira Juan C, Brakenridge Scott C, Moldawer Lyle L, Moore Frederick A
Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, 1600 Southwest Archer Road, PO Box 100019, Gainesville, FL 32610-0019, USA.
Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, 1600 Southwest Archer Road, Room 6116, PO Box 100286, Gainesville, FL 32610-0286, USA.
Crit Care Clin. 2017 Apr;33(2):245-258. doi: 10.1016/j.ccc.2016.12.001.
Following advances in critical care, in-hospital multiple organ failure-related mortality is declining. Consequently, incidence of chronic critical illness is increasing. These patients linger in the intensive care unit, have high resource utilization, and poor long-term outcomes. Within this population, the authors propose that a substantial subset of patients have a new phenotype: persistent inflammation, immunosuppression, and catabolism syndrome. There is evidence that myelodysplasia with expansion of myeloid-derived suppressor cells, innate and adaptive immune suppression, and protein catabolism with malnutrition are major contributors. Optimal care of these patients will require novel multimodality interventions.
随着重症监护技术的进步，医院内与多器官功能衰竭相关的死亡率正在下降。因此，慢性危重病的发病率正在上升。这些患者在重症监护病房长期逗留，资源利用率高，长期预后不佳。在这一人群中，作者提出相当一部分患者具有一种新的表型：持续性炎症、免疫抑制和分解代谢综合征。有证据表明，骨髓发育异常伴髓源性抑制细胞扩增、先天性和适应性免疫抑制以及伴有营养不良的蛋白质分解代谢是主要原因。对这些患者的最佳治疗将需要新的多模式干预措施。
