Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Neonatology, Berlin, Germany.
Acta Physiol (Oxf). 2023 May;238(1):e13962. doi: 10.1111/apha.13962. Epub 2023 Mar 31.
Patients admitted to the intensive care unit (ICU) are in need of continuous organ replacement strategies and specialized care, for example because of neurological dysfunction, cardio-pulmonary instability, liver or kidney failure, trauma, hemorrhagic or septic shock or even preterm birth. The 24-h nursing and care interventions provided to critically ill patients significantly limit resting and/or recovery phases. Consecutively, the patient's endogenous circadian rhythms are misaligned and disrupted, which in turn may interfere with their critical condition. A more thorough understanding of the complex interactions of circadian effectors and tissue-specific molecular clocks could therefore serve as potential means for enhancing personalized treatment in critically ill patients, conceivably restoring their circadian network and thus accelerating their physical and neurocognitive recovery. This review addresses the overarching issue of how circadian rhythms are affected and disturbed in critically ill newborns and adults in the ICU, and whether the conflicting external or environmental cues in the ICU environment further promote disruption and thus severity of illness. We direct special attention to the influence of cell-type specific molecular clocks on with severity of organ dysfunctions such as severity of brain dysfunction, pneumonia- or ventilator-associated lung inflammation, cardiovascular instability, liver and kidney failure, trauma, and septic shock. Finally, we address the potential of circadian rhythm stabilization to enhance and accelerate clinical recovery.
入住重症监护病房（ICU）的患者需要持续的器官替代策略和专业护理，例如由于神经功能障碍、心肺不稳定、肝或肾功能衰竭、创伤、出血性或感染性休克甚至早产。危重病患者提供的 24 小时护理和护理干预措施极大地限制了休息和/或恢复阶段。因此，患者的内源性昼夜节律被打乱和破坏，这反过来又可能干扰他们的危急状况。因此，更深入地了解昼夜节律效应器和组织特异性分子钟的复杂相互作用，可以作为增强危重病患者个性化治疗的潜在手段，可能恢复他们的昼夜节律网络，从而加速他们的身体和神经认知恢复。这篇综述探讨了 ICU 中危重病新生儿和成人的昼夜节律如何受到影响和干扰的问题，以及 ICU 环境中相互冲突的外部或环境线索是否会进一步促进昼夜节律的破坏，从而加重疾病的严重程度。我们特别关注细胞类型特异性分子钟对器官功能障碍严重程度的影响，例如脑功能障碍、肺炎或呼吸机相关性肺炎症、心血管不稳定、肝和肾功能衰竭、创伤和感染性休克的严重程度。最后，我们探讨了稳定昼夜节律以增强和加速临床恢复的潜力。
