Immunologic Consequences of Hypoxia during Critical Illness

Kiers, Dorien; Scheffer, Gert-Jan; Hoeven, Johannes G. van der; Eltzschig, Holger K.; Pickkers, Peter; Kox, Matthijs

doi:10.1097/aln.0000000000001163

Cited by 24 publications

(17 citation statements)

References 132 publications

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“…The data of the RCT “Optimal Oxygenation in the Intensive Care Unit (O2-ICU)” (NCT02321072) comparing PaO 2 targets of 120 versus 75 mmHg in ICU patients and the detailed results of the preliminary terminated 2 × 2-factorial RCT “Hyperoxia and Hypertonic Saline in Septic Shock (Hyper2S)” (NCT01722422), simultaneously comparing target SaO 2 88–95 % versus pure O 2 ventilation during the first 24 h and isotonic versus hypertonic saline, are therefore eagerly awaited. The results may allow finding criteria for “…a personalized O 2 target…in critically ill patients” [ 14 ]. Until then, conservative O 2 therapy [ 1 , 2 ] should be the treatment of choice to avoid both hypoxemia and excess hyperoxia.…”

Section: Discussionmentioning

confidence: 99%

“…Clearly, patients with VAP were older, sicker, and, in particular, more frequently in shock prior to ICU admission. First, shock, as the dysbalance between tissue O 2 supply and demand leads to tissue hypoxia, which in turn triggers hyper-inflammation that is aimed to clear pathogens [ 14 ]. However, when “too pronounced and/or sustained”, tissue hypoxia may cause anti-inflammation, thereby rendering patients more susceptible to secondary infection [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Does hyperoxia enhance susceptibility to secondary pulmonary infection in the ICU?

et al. 2016

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Hyperoxia is common practice in the acute management of circulatory shock, and observational studies report that it is present in more than 50 % of mechanically ventilated patients during the first 24 h after intensive care unit (ICU) admission. On the other hand, “oxygen toxicity” due to the increased formation of reactive oxygen species limits its use due to serious deleterious side effects. However, formation of reactive oxygen species to boost bacterial killing is one of the body’s anti-microbial auto-defense mechanisms and, hence, O2 has been referred to as an antibiotic. Consequently, hyperoxia during the peri-operative period has been advocated for surgical patients in order to reduce surgical site infection. However, there is ample evidence that long-term exposure to hyperoxia impaired bacterial phagocytosis and thereby aggravated both bacterial burden and dissemination. Moreover, a recent retrospective study identified the number of days with hyperoxia, defined as a PaO2 > 120 mmHg only, as an independent risk factor of ventilator-associated pneumonia in patients needing mechanical ventilation for more than 48 h. Since so far the optimal oxygenation target is unknown for ICU patients, “conservative” O2 therapy represents the treatment of choice to avoid exposure to both hypoxemia and excess hyperoxemia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does hyperoxia enhance susceptibility to secondary pulmonary infection in the ICU?

et al. 2016

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“…Phagocytosis is affected by many physico-chemical factors, many of which are readily influenced in critically ill patients. For example, an elevation in phagocytic capacity has been reported in conditions such as hyperthermia ( 102 ), hypoxia ( 103 ), and high insulin levels ( 104 ). All of these conditions can be a component of early sepsis syndrome and we suggest that they might be part of an evolutionary adaptation to systemic infection.…”

Section: Routine Therapeutic Approaches Influencing Phagocytic Procesmentioning

confidence: 99%

Phagocytosis–Inflammation Crosstalk in Sepsis: New Avenues for Therapeutic Intervention

Hortová-Kohoutková

Tidu

Zuani

et al. 2020

Shock

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Phagocytosis is a complex process by which cells within most organ systems remove pathogens and cell debris. Phagocytosis is usually followed by inflammatory pathway activation, which promotes pathogen elimination and inhibits pathogen growth. Delayed pathogen elimination is the first step in sepsis development and a key factor in sepsis resolution. Phagocytosis thus has an important role during sepsis and likely contributes to all of its clinical stages. However, only a few studies have specifically explored and characterized phagocytic activity during sepsis. Here, we describe the phagocytic processes that occur as part of the immune response preceding sepsis onset and identify the elements of phagocytosis that might constitute a predictive marker of sepsis outcomes. First, we detail the key features of phagocytosis, including the main receptors and signaling hallmarks associated with different phagocytic processes. We then discuss how the initial events of phagosome formation and cytoskeletal remodeling might be associated with known sepsis features, such as a cytokine-driven hyperinflammatory response and immunosuppression. Finally, we highlight the unresolved mechanisms of sepsis development and progression and the need for cross-disciplinary approaches to link the clinical complexity of the disease with basic cellular and molecular mechanisms.

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“…Oxygen deficiency is one of the key factors in the development of infectious, inflammatory, and tumor diseases [ 1 , 2 , 3 , 4 , 5 , 6 ]. It is known that basic tolerance to hypoxia in humans and various animal species differs [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Differences in Tolerance to Hypoxia: Physiological, Biochemical, and Molecular-Biological Characteristics

Джалилова

Makarova

2020

Biomedicines

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Hypoxia plays an important role in the development of many infectious, inflammatory, and tumor diseases. The predisposition to such disorders is mostly provided by differences in basic tolerance to oxygen deficiency, which we discuss in this review. Except the direct exposure of different-severity hypoxia in decompression chambers or in highland conditions, there are no alternative methods for determining organism tolerance. Due to the variability of the detection methods, differences in many parameters between tolerant and susceptible organisms are still not well-characterized, but some of them can serve as biomarkers of susceptibility to hypoxia. At the moment, several potential biomarkers in conditions after hypoxic exposure have been identified both in experimental animals and humans. The main potential biomarkers are Hypoxia-Inducible Factor (HIF)-1, Heat-Shock Protein 70 (HSP70), and NO. Due to the different mechanisms of various high-altitude diseases, biomarkers may not be highly specific and universal. Therefore, it is extremely important to conduct research on hypoxia susceptibility biomarkers. Moreover, it is important to develop a method for the evaluation of organisms’ basic hypoxia tolerance without the necessity of any oxygen deficiency exposure. This can contribute to new personalized medicine approaches’ development for diagnostics and the treatment of inflammatory and tumor diseases, taking into account hypoxia tolerance differences.

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Immunologic Consequences of Hypoxia during Critical Illness

Cited by 24 publications

References 132 publications

Does hyperoxia enhance susceptibility to secondary pulmonary infection in the ICU?

Does hyperoxia enhance susceptibility to secondary pulmonary infection in the ICU?

Phagocytosis–Inflammation Crosstalk in Sepsis: New Avenues for Therapeutic Intervention

Differences in Tolerance to Hypoxia: Physiological, Biochemical, and Molecular-Biological Characteristics

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