Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: Time for a reevaluation

Abraham, Edward; Matthay, Michael A.; Dinarello, Charles A.; Vincent, Jean‐Louis; Cohen, Jonathan; Opal, Steven M.; Glauser, M. P.; Parsons, Polly E.; Fisher, Charles J.; Repine, John E.

doi:10.1097/00003246-200001000-00039

Cited by 326 publications

(156 citation statements)

References 24 publications

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“…This is, at least in part, to be blamed on the lack of understanding of the underlying pathophysiological processes, which itself is aggravated by the deficiency of clear definitions and the heterogeneity of the diseases summarized under the concept of ALI. To overcome this deficit, a disease entity-based subgrouping (5) and a reevaluation of the definition of ARDS (6) have been demanded. In this respect, it has been recognized that ALI can be differentiated into direct ALI (ALI direct ) and indirect ALI (ALI indirect ) by taking into account potentially dissimilar pathophysiology, different radiological manifestations and respiratory mechanics, as well as the disparate susceptibility to ventilatory strategies (5,(7)(8)(9)(10)(11).…”

mentioning

confidence: 99%

Fas-induced Pulmonary Apoptosis and Inflammation during Indirect Acute Lung Injury

Perl

Chung²,

Perl³

et al. 2007

Am J Respir Crit Care Med

140

145

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Rationale: Indirect acute lung injury (ALI) is associated with high morbidity and mortality. No specific therapies have been developed, because the underlying pathophysiological processes remain elusive. Objectives: To investigate the contribution of Fas-induced apoptotic and nonapoptotic/inflammatory signaling to the pathology of indirect ALI. Methods: A mouse model of indirect ALI, induced by successive exposure to hemorrhagic shock and cecal ligation and puncture, was used. Quantification of active caspase-3 and the short splice variant of FLICE-inhibitory protein, (FLIP) short , was performed by Western blotting and immunohistochemistry, and cytokines/chemokines were assessed by cytometric bead array or ELISA. M30 immunostaining was done to evaluate epithelial cell apoptosis. Lung injury was assessed on the basis of myeloperoxidase activity, bronchoalveolar lavage protein, and lung histology. Measurements and Main Results: Twelve hours after insult, lung monocyte chemoattractant protein-1, keratinocyte-derived chemokine, macrophage inflammatory protein-2, IL-6, tumor necrosis factor-a, and caspase-3 were increased and FLIP short was decreased. Fas-and Fas ligand-deficient mice showed marked protection from lung inflammation and apoptosis and decreased ALI. This was associated with a 10-day survival benefit. Similarly, 4 hours after pulmonary instillation of Fas-activating antibody in vivo, lung chemokines were markedly elevated in background mice and, interestingly, to a similar degree in macrophage-deficient animals. Fas activation on lung epithelial cells in vitro led to chemokine production that was dependent on extracellular signal-regulated kinase. Conclusions: Activation of apoptotic and nonapoptotic/inflammatory Fas signaling is an early important pathophysiological event in the development of indirect ALI after hemorrhagic shock and sepsis, in which lung epithelial cells appear to play a central role.

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mentioning

confidence: 99%

Fas-induced Pulmonary Apoptosis and Inflammation during Indirect Acute Lung Injury

Perl

Chung²,

Perl³

et al. 2007

Am J Respir Crit Care Med

140

145

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“…TRALI in TACO je težko ločiti med seboj, saj je klinična slika zelo podobna, pri TRALI gre namreč za nekardiogeni, pri TACO pa kardiogeni pljučni edem (32). V pomoč so nam lahko vrednosti krvnega tlaka (pri TRALI so značilno nizke, pri TACO pa visoke) in povišana telesna temperatura (TRALI), pri TRALI lahko beležimo v hemogramu tudi prehodno levkopenijo (33)(34)(35)(36). Poleg tega nam je v pomoč tudi NT proBNP, ki je kazalec srčnega popuščanja in je tipično povišan pri TACO ter načeloma nizek pri TRA-LI (37,38).…”

Section: Obravnava In Zdravljenje Respiratornih Transfuzijskih Reakcijunclassified

Respiracijske transfuzijske reakcije

Marić¹,

Mlakar

Bricl³

2017

SlovMedJour

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IzvlečekTransfuzijske reakcije niso pogoste, vendar kljub temu verjetno pogostejše, kot jih ocenjujemo na splošno, saj je prepoznavanje in poročanje o transfuzijskih reakcijah še vedno pomanjkljivo. Čla-nek opisuje najpogostejše respiracijske transfuzijske reakcije, patofiziologijo le-teh, klinično sliko in zdravljenje. Med primarnimi transfuzijskimi reakcijami so najpomembnejše: s transfuzijo povezana akutna okvara pljuč oz. TRALI, s transfuzijo povezana volumska preobremenitev oz. TACO ter s transfuzijo povezana dispneja oz. TAD. Pri TRALI pride do aktiviranja imunskega sistema, katerega posledica je povečana prepustnost bazalne membrane v pljučnih mešičkih, kar vodi v nekardiogeni pljučni edem. Zdravljenje je podporno z dodajanjem kisika, tekočin ob hipotenziji, v hujših primerih dihalne odpovedi tudi mehansko predihavanje. Klinična slika TACO je kardiogeni pljučni edem, do katerega pride zaradi volumske obremenitve pri predisponiranih osebah, ki so: dojenčki, starostniki, bolniki s srčnim popuščanjem, anemijo in bolniki s pozitivno tekočinsko bilanco. TACO zdravimo po načelih zdravljenja kardiogenega pljučnega edema z dodajanjem kisika, diuretiki, po potrebi pa tudi z neinvazivnim ali invazivnim mehanskim predihavanjem. Pri TAD pa gre za etiološko nepojasnjeno dispnejo, ki se pojavi po transfuziji in je ne moremo opredeliti kot TACO ali TRALI, prav tako pa je ne pojasnijo bolnikove kronične bolezni. Ponavadi je TAD blaga reakcija. Čeprav transfuzijske reakcije niso zelo pogoste, je znanje o prepoznavanju, zdravljenju in preprečevanju respiracijskih transfuzijskih reakcij nujno potrebno, da se preprečijo resne posledice pri bolnikih. AbstractRespiratory transfusion-related reactions are not very frequent, partly also because recognition and reporting transfusion reactions is still underemphasized. This article describes the most important respiratory transfusion reactions, their pathophysiology, clinical picture and treatment strategies. Respiratory transfusion related reactions can be primary or secondary. The most important primary transfusion-related reactions are TRALI -transfusion-related acute lung injury, TACO -transfusion-associated circulatory overload, and TAD -transfusion-associated dyspnea. TRALI is immuneassociated injury of alveolar basal membrane, which becomes highly permeable and causes noncardiogenic pulmonary edema. Treatment of TRALI is mainly supportive with oxygen, fluids (in case of hypotension) and in cases of severe acute respiratory failure also mechanic ventilation. TACO is caused by volume overload in predisposed individuals, such as patients with heart failure, the elderly, infants, patients with anemia and patients with positive fluid balance. Clinical picture is that of a typical pulmonary cardiogenic edema, and the therapy is classical: oxygen and diuretics, and in severe cases also non-invasive or invasive mechanical ventilation. TAD is usually a mild reaction of unknown cause and cannot be classified as TACO or TRALI, nor can it be ascribed to patient's preexisting diseases. ...

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“…No obstante, este problema semántico no parece todavía estar del todo resuelto y desde luego siguen surgiendo voces críticas que claman la necesidad de precisar todavía más el contexto clínico que envuelve al paciente con una sepsis (8)(9)(10)(11)(12). En efecto, según tales voces, las definiciones propuestas por la Conferencia de Consenso de la ACCP/SCCM adolecen de ser todavía demasiado amplias.…”

Section: Tabla Iunclassified

Sepsis y shock séptico: un torbellino de mediadores inflamatorios de difícil manejo terapéutico

Giménez-Rico

Reyero

Ruigomez

et al. 2002

An. Med. Interna (Madrid)

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INTRODUCCIÓNEn los últimos años se ha producido un extraordinario aumento en la incidencia de la sepsis y el shock séptico (1) por lo que nos enfrentamos a un capítulo dentro de la medicina de enorme interés y debate, no sólo ya por su creciente aparición, sino también por tratarse, en los albores del sigo XXI, de un auténtico reto terapéutico pendiente de una solución definitiva. No hay que olvidar que su mortalidad oscila entre el 35-80% y que ésta, apenas ha variado en las dos últimas décadas a pesar de los enormes progresos en el conocimiento de su fisiopatología y de las novedades curativas y de soporte vital surgidas en los últimos tiempos (2,3).La sepsis y el shock séptico constituyen, sin duda, una realidad clínica en la que los mediadores químicos de la inflamación propios del organismo desempeñan un papel relevante en su explicación fisiopatológica. Dentro de la biología quirúrgica el estudio de estos mediadores es donde quizás estén siendo más evidentes los avances en biología molecular y celular. El actual interés que ha suscitado este estudio no nos debe sorprender y ello se debe, fundamentalmente, a dos razones. Por un lado, una gran parte de la morbimortalidad asociada con la práctica quirúrgica diaria es debida a anomalías en la respuesta inflamatoria; por el otro, es cada vez más patente en la patogenia de afecciones tan dispares como la artritis reumatoide, el asma bronquial, el infarto cerebral o el síndrome de distrés respiratorio del adulto, todas ellas, pertenecientes a distintas especialidades médico-quirúrgicas, la alteración en la síntesis de tales mediadores (4).47 [0212-7199(2002) RESUMENLa sepsis y el shock séptico continúan siendo un capítulo de enorme interés por su elevada frecuencia, y por no existir una disminución en las cifras de mortalidad a pesar de los nuevos conocimientos adquiridos en su fisiopatología y los avances surgidos en los diversos tratamientos aplicados.El propósito de la presente revisión es actualizar los conceptos presentes en la literatura especializada, tratando de resumir la compleja interacción existente entre diferentes mediadores de doble carácter: exóge-nos y endógenos, y enunciar las posibles causas por las que los tratamientos novedosos aplicados en la sepsis siguen siendo poco prometedores.

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Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: Time for a reevaluation

Cited by 326 publications

References 24 publications

Fas-induced Pulmonary Apoptosis and Inflammation during Indirect Acute Lung Injury

Fas-induced Pulmonary Apoptosis and Inflammation during Indirect Acute Lung Injury

Respiracijske transfuzijske reakcije

Sepsis y shock séptico: un torbellino de mediadores inflamatorios de difícil manejo terapéutico

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