Mechanisms of the systemic inflammatory response

Asimakopoulos, George

doi:10.1177/026765919901400406

Cited by 105 publications

(76 citation statements)

References 82 publications

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“…Thus, what initially can be a localized immune reaction spreads to a generalized, systemic response with increased levels of cytokines in the circulation [12,76] (Table 2). In cardiac surgery, cardiopulmonary bypass appears to be a major factor for activation of complement and secretion of proinflammatory cytokines contributing to post-operative multi-organ dysfunction [6]. Reversely, off-pump procedures are associated with a lesser degree of plasmatic inflammatory mediators and improved function of major organs and post-operative cognitive performance [35].…”

Section: Clinical Conditions With Systemic Inflammatory Reactions To mentioning

confidence: 99%

“…sepsis, urinary tract, pneumonia, and abscess) [123,144] Trauma [50,83], surgery [12,76] Burns [71] Neoplasm (primary, metastasis and paraneoplastic syndrome) [80] Cardiac Myocardial infarction [90], cardiac surgery [6] Haematological Leukaemia, stem cell transplant [129] Renal Renal failure [128] Hepatic Hepatitis, cirrhosis, hepatic failure [121] Orthopaedic Fractures [140] Acta Neuropathol changes in BBB. Increased BBB permeability and altered expression of tight-junctional proteins were reported in three different inflammatory models (Table 3).…”

Section: Disruption Of Blood-brain Barriermentioning

confidence: 99%

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The neuroinflammatory hypothesis of delirium

et al. 2010

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Delirium is a neuropsychiatric syndrome characterized by a sudden and global impairment in consciousness, attention and cognition. It is particularly frequent in elderly subjects with medical or surgical conditions and is associated with short-and long-term adverse outcomes. The pathophysiology of delirium remains poorly understood as it involves complex multi-factorial dynamic interactions between a diversity of risk factors. Several conditions associated with delirium are characterized by activation of the inflammatory cascade with acute release of inflammatory mediators into the bloodstream. There is compelling evidence that acute peripheral inflammatory stimulation induces activation of brain parenchymal cells, expression of proinflammatory cytokines and inflammatory mediators in the central nervous system. These neuroinflammatory changes induce neuronal and synaptic dysfunction and subsequent neurobehavioural and cognitive symptoms. Furthermore, ageing and neurodegenerative disorders exaggerate microglial responses following stimulation by systemic immune stimuli such as peripheral inflammation and/or infection. In this review we explore the neuroinflammatory hypothesis of delirium based on recent evidence derived from animal and human studies.

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Section: Clinical Conditions With Systemic Inflammatory Reactions To mentioning

confidence: 99%

Section: Disruption Of Blood-brain Barriermentioning

confidence: 99%

The neuroinflammatory hypothesis of delirium

et al. 2010

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“…The activation of the complementary system leads to leukocyte activation, causing, a number of times, the interruption of the normal endothelial barrier, tissue edema, and organ failure [16,17]. Of the blood elements, the one which is most affected by the destructive influence of CPB circuit is the leukocyte due to the direct trauma, followed by cellular destruction or functional deficit.…”

Section: Discussionmentioning

confidence: 99%

“…During CPB, the leukocytes migrate towards the lungs, releasing toxic substances that cause increased vascular patency and interstitial edema. CPB is often associated to early neutropenia, followed by neutrophilia in the immediate postoperative period [16,17].…”

Section: Discussionmentioning

confidence: 99%

Avaliação de oxigenador de membrana infantil em ovinos

Finoti¹,

Braile²,

Croti³

et al. 2008

Rev Bras Cir Cardiovasc

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“…17 Multi-organ failure is a common postoperative complication after major surgery. 18 It resembles the clinical outcome of adult respiratory disease syndrome 19 and septic shock, [18][19][20][21] results in prolonged stay in intensive care, and is a major cause of death. We investigated whether removal of allogeneic leucocytes reduces postoperative complications in patients undergoing major surgery.…”

Section: Introductionmentioning

confidence: 99%

Effects of Transfusion with Red Cells Filtered to Remove Leucocytes: Randomised Controlled Trial in Patients Undergoing Major Surgery

2004

The Journal of the American Association of Gynecologic Laparosc

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Objective To compare postoperative complications in patients undergoing major surgery who received non-filtered or filtered red blood cell transfusions. Design Prospective, randomised, double blinded trial. Setting 19 hospitals throughout the Netherlands (three university; 10 clinical; six general). Participants 1051 evaluable patients: 79 patients with ruptured aneurysm, 412 patients undergoing elective surgery for aneurysm, and 560 undergoing gastrointestinal surgery. Interventions The non-filtered products had the buffy coat removed and were plasma reduced. The filtered products had the buffy coat removed, were plasma reduced, and filtered before storage to remove leucocytes. Main outcome measures Mortality and duration of stay in intensive care. Secondary end points were occurrence of multi-organ failure, infections, and length of hospital stay. Results No significant differences were found in mortality (odds ratio for filtered v non-filtered 0.80, 95% confidence interval 0.53 to 1.21) and in mean stay in intensive care ( − 0.4 day, − 1.6 to 0.6 day). In the filtered group the mean length of hospital stay was 2.4 days shorter ( − 4.8 to 0.0 day; P = 0.050) and the incidence of multi-organ failure was 30% lower (odds ratio 0.70, 0.49 to 1.00; P = 0.050). There were no differences in rates of infection (0.98, 0.73 to 1.32). Conclusion The use of filtered transfusions in some types of major surgery may reduce the length of hospital stay and the incidence of postoperative multi-organ failure.

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Mechanisms of the systemic inflammatory response

Cited by 105 publications

References 82 publications

The neuroinflammatory hypothesis of delirium

The neuroinflammatory hypothesis of delirium

Avaliação de oxigenador de membrana infantil em ovinos

Effects of Transfusion with Red Cells Filtered to Remove Leucocytes: Randomised Controlled Trial in Patients Undergoing Major Surgery

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