Severe sepsis—a major challenge for critical care

Dolan, Shelley

doi:10.1016/s0964-3397(03)00017-x

Intensive and Critical Care Nursing

2003

DOI: 10.1016/s0964-3397(03)00017-x

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Severe sepsis—a major challenge for critical care

Shelley Dolan¹

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Cited by 5 publications

(1 citation statement)

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“…S epsis is one of the major causes of morbidity and mortality in the intensive care unit (1). Exposure to bacterial products differentially initiates activation and migration of leukocyte subsets (2,3).…”

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confidence: 99%

Selective Activation of Peripheral Blood T Cell Subsets by Endotoxin Infusion in Healthy Human Subjects Corresponds to Differential Chemokine Activation

Miller-Graziano

Calvano³

et al. 2005

The Journal of Immunology

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Although activation of human innate immunity after endotoxin administration is well established, in vivo endotoxin effects on human T cell responses are not well understood. Most naive human T cells do not express receptors for LPS, but can respond to endotoxin-induced mediators such as chemokines. In this study, we characterized the in vivo response of peripheral human T cell subsets to endotoxin infusion by assessing alterations in isolated T cells expressing different phenotypes, intracellular cytokines, and systemic chemokines concentration, which may influence these indirect T cell responses. Endotoxin administration to healthy subjects produced T cell activation as confirmed by a 20% increase in intracellular IL-2, as well as increased CD28 and IL-2R α-chain (CD25) expression. Endotoxin induced indirect activation of T cells was highly selective among the T cell subpopulations. Increased IL-2 production (36.0 ± 3.7 to 53.2 ± 4.1) vs decreased IFN-γ production (33.8 ± 4.2 to 19.1 ± 3.2) indicated selective Th1 activation. Th2 produced IL-13 was minimally increased. Differentially altered chemokine receptor expression also indicated selective T cell subset activation and migration. CXCR3+ and CCR5+ expressing Th1 cells were decreased (CXCR3 44.6 ± 3.2 to 33.3 ± 4.6 and CCR5 24.8 ± 2.3 to 12 ± 1.4), whereas plasma levels of their chemokine ligands IFN-γ-inducible protein 10 and MIP-1α were increased (61.4 ± 13.9 to 1103.7 ± 274.5 and 22.8 ± 6.2 to 55.7 ± 9.5, respectively). In contrast, CCR4+ and CCR3 (Th2) proportions increased or remained unchanged whereas their ligands, eotaxin and the thymus and activation-regulated chemokine TARC, were unchanged. The data indicate selective activation among Th1 subpopulations, as well as differential Th1/Th2 activation, which is consistent with a selective induction of Th1 and Th2 chemokine ligands.

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mentioning

confidence: 99%

Selective Activation of Peripheral Blood T Cell Subsets by Endotoxin Infusion in Healthy Human Subjects Corresponds to Differential Chemokine Activation

Miller-Graziano

Calvano³

et al. 2005

The Journal of Immunology

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From A&E to ICU: how nurses can support the Surviving Sepsis Campaign

Robson

2004

Intensive and Critical Care Nursing

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Portfolio zur strategischen Steuerung der Entwicklung einer Intensivstation zum Referenzzentrum

Schubert

Wehrli

Spirig

2009

Pflege

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This article describes the development and content of the portfolio of the Surgical Intensive Care Unit. The first step was to evaluate clinical practice using a SWOT (strengths, weakness, opportunities and threats) analysis; development and trends within surgical intensive care were analyzed with a literature search. From these results, three areas were identified as essential for the development of practice: (1) best practice/best care, (2) research, and (3) development into a reference center. For each area, clearly specified objectives, outcomes, measures, responsibilities, and resources were defined and an extensive multi-year action plan was established. Best Practice/Best Care consisted of the improvement of performance and patient outcomes, the support and promotion of personnel, and the implementation of evidence-based nursing practice. Combining Best Practice/Best Care with the goals and measures of the second area, Research, formed the basis for realizing the vision of the Surgical Intensive Care Unit to become "a nationally and internationally recognized reference center for surgical intensive care for defined topics and patient groups." Concrete strategies for achieving this goal were established in the third area.

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Severe sepsis—a major challenge for critical care

Cited by 5 publications

References 30 publications

Selective Activation of Peripheral Blood T Cell Subsets by Endotoxin Infusion in Healthy Human Subjects Corresponds to Differential Chemokine Activation

Selective Activation of Peripheral Blood T Cell Subsets by Endotoxin Infusion in Healthy Human Subjects Corresponds to Differential Chemokine Activation

From A&E to ICU: how nurses can support the Surviving Sepsis Campaign

Portfolio zur strategischen Steuerung der Entwicklung einer Intensivstation zum Referenzzentrum

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