Immunomodulation in the critically ill

• Published in: British journal of anaesthesia : BJA Vol. 103; no. 1; pp. 70 - 81
• Main Authors: Webster, N.R., Galley, H.F.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.07.2009; Oxford University Press; Oxford Publishing Limited (England); British Journal of Anaesthesia. Published by Elsevier Ltd
• Subjects: adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Critical Illness - therapy; cytokines; Cytokines - antagonists & inhibitors; Cytokines - immunology; Glucocorticoids - therapeutic use; Humans; immune system; Immunologic Factors - therapeutic use; Immunotherapy - methods; intensive care; Medical sciences; Respiratory Distress Syndrome, Adult - immunology; Respiratory Distress Syndrome, Adult - therapy; respiratory distress system; respiratory distress system, adult; Review; Sepsis - immunology; Sepsis - therapy; Systemic Inflammatory Response Syndrome - immunology; Systemic Inflammatory Response Syndrome - therapy; systemic inflammatory response system; immune system; cytokines; intensive care; systemic inflammatory response system; respiratory distress system, adult; Intensive care; Respiratory disease; Immunomodulation; Critically ill; respiratory distress system; Cytokine; Respiratory system; Anesthesia; Respiratory distress; adult; Immune system
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aep128

Immunotherapy in the critically ill is an appealing notion because of the apparent abnormal immune and inflammatory responses seen in so many patients. The administration of a medication that could alter immune responses and decrease mortality in patients with sepsis could represent a ‘magic bullet’. Various approaches have been tried over the last 20 yr: steroids; anti-endotoxin or anti-cytokine antibodies; cytokine receptor antagonists; and other agents with immune-modulating side-effects. However, in some respects, research along these lines has been unsuccessful or disappointing at best. The current state of knowledge is summarized with particular reference to sepsis and the acute respiratory distress syndrome.