Persistent inflammation, immunosuppression, and catabolism syndrome (PICS): a review of definitions, potential therapies, and research priorities

British Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: 132(3), P. 507 - 518

Published: Jan. 4, 2024

Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) is a clinical endotype of chronic critical illness. PICS consists self-perpetuating cycle ongoing organ dysfunction, inflammation, catabolism resulting in sarcopenia, immunosuppression leading to recurrent infections, metabolic derangements, changes bone marrow function. There heterogeneity regarding the definition PICS. Currently, there are no licensed treatments specifically for However, findings can be extrapolated from studies other conditions with similar features repurpose drugs, animal models. Drugs that restore immune homeostasis by stimulating lymphocyte production could have potential efficacy. Another treatment modifying myeloid-derived suppressor cell (MDSC) activation after day 14 when they immunosuppressive. such as interleukin (IL)-1 IL-6 receptor antagonists might reduce persistent although need given at specific time points avoid adverse effects. Antioxidants treat oxidative stress caused mitochondrial dysfunction Possible anti-catabolic agents include testosterone, oxandrolone, IGF-1 (insulin-like growth factor-1), bortezomib, MURF1 (muscle RING-finger protein-1) inhibitors. Nutritional support strategies slow progression ketogenic feeding probiotics. The field would benefit consensus using biologically based cut-off values. Future research should focus on expanding knowledge underlying pathophysiological mechanisms identify validate endotypes illness subsequent treatable traits. unlikely universal PICS, multimodal, timely, personalised therapeutic strategy will needed improve outcomes this growing cohort patients.

Language: Английский

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Gut mycobiome dysbiosis after sepsis and trauma

Critical Care, Journal Year: 2024, Volume and Issue: 28(1)

Published: Jan. 11, 2024

Abstract Background Sepsis and trauma are known to disrupt gut bacterial microbiome communities, but the impacts perturbations in fungal (mycobiome) community after severe infection or injury, particularly patients experiencing chronic critical illness (CCI), remain unstudied. Methods We assess persistence of mycobiome perturbation (dysbiosis) CCI following sepsis for up two-to-three weeks intensive care unit hospitalization. Results show that dysbiotic arrays shift toward a pathobiome state, which is more susceptible infection, compared age-matched healthy subjects. The largely dominated by Candida spp; while, commensal species depleted. Additionally, these myco-pathobiome correlate with alterations micro-ecological niche involving specific bacteria gut-blood metabolites. Conclusions findings reveal dysbiosis both settings, even two post-sepsis trauma, highlighting need address increased risk infections patients. Graphical

Language: Английский

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Transforming research to improve therapies for trauma in the twenty-first century

Critical Care, Journal Year: 2024, Volume and Issue: 28(1)

Published: Feb. 13, 2024

Abstract Improvements have been made in optimizing initial care of trauma patients, both prehospital systems as well the emergency department, and these also favorably affected longer term outcomes. However, specific treatments for bleeding are largely lacking, many patients continue to die from hemorrhage. Also, major knowledge gaps remain on impact tissue injury host immune coagulation response, which hampers development interventions treat or prevent organ failure, thrombosis, infections other complications trauma. Thereby, remains a challenge intensivists. This review describes most pressing research questions trauma, new approaches research, with aim bring improved therapies bedside within twenty-first century.

Language: Английский

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Disseminated Intravascular Coagulopathy and Persistent Inflammation, Immunosuppression, and Catabolism Syndrome: Pathophysiology, Shared Pathways, and Clinical Implications

Published: Jan. 1, 2025

Language: Английский

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cccccStrengthening trauma resuscitation education and training in low-resource settings: a call for global inclusion

Resuscitation Plus, Journal Year: 2025, Volume and Issue: unknown, P. 100935 - 100935

Published: March 1, 2025

Trauma is a leading cause of preventable death worldwide, disproportionately affecting low-resource settings where access to specialized care limited. Systemic barriers, including fragmented trauma networks and workforce shortages, contribute poor outcomes. Strengthening resuscitation through structured education training critical improving survival reducing disparities. However, traditional models often fail address regional constraints, limiting their effectiveness. Brazil has developed comprehensive model by integrating public awareness campaigns, medical student-led initiatives, digital learning, simulation-based training, telemedical support. A horizontal approach patient management, combined with hands-on immersive simulation further enhanced this framework, emphasizing the team non-technical skills essential for high-performance care. This narrative review examines Brazil's strategies explores potential serve as template settings. By analyzing key educational components, we identify cost-effective solutions strengthen system capacity. To bridge disparities, must extend beyond well-resourced environments. Faculty development, sustainable mentorship, technology-driven are equipping providers needed manage complex scenarios. Mobile units telemedicine platforms expand remote regions, while scalable enable real-time collaboration. Despite these advancements, funding logistical need culturally tailored hinder widespread implementation. Embedding into national health policies disaster response systems ensuring sustainable, high-quality worldwide.

Language: Английский

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Disseminated Intravascular Coagulopathy and Persistent Inflammation, Immunosuppression, and Catabolism Syndrome: Pathophysiology, shared pathways, and clinical implications

Thrombosis Research, Journal Year: 2025, Volume and Issue: unknown, P. 109321 - 109321

Published: April 1, 2025

Language: Английский

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Adverse outcomes and an immunosuppressed endotype in septic patients with reduced IFN-γ ELISpot

JCI Insight, Journal Year: 2023, Volume and Issue: 9(2)

Published: Dec. 15, 2023

BACKGROUND. Sepsis remains a major clinical challenge for which successful treatment requires greater precision in identifying patients at increased risk of adverse outcomes requiring different therapeutic approaches. Predicting and immunological endotyping septic has generally relied on using blood protein or mRNA biomarkers, static cell phenotyping. Here, we sought to determine whether functional immune responsiveness would yield improved precision.

Language: Английский

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TEMPORAL CHANGES IN INNATE AND ADAPTIVE IMMUNITY DURING SEPSIS AS DETERMINED BY ELISPOT

Shock, Journal Year: 2024, Volume and Issue: 62(2), P. 255 - 264

Published: May 3, 2024

Background: The inability to evaluate host immunity in a rapid quantitative manner patients with sepsis has severely hampered development of novel immune therapies. enzyme-linked immunospot (ELISpot) assay is functional bioassay that measures the number cytokine-secreting cells and relative amount cytokine produced at single-cell level. A key advantage ELISpot its excellent dynamic range enabling more precise quantifiable assessment immunity. Herein, we tested hypothesis can detect changes both innate adaptive as they often occur during sepsis. We also whether could effect drug therapies modulate Methods: Mice were made septic using sublethal cecal ligation puncture. Blood spleens harvested serially, ex vivo interferon γ TNF-α production compared by immunosorbent assay. capability due therapy dexamethasone, IL-7, arginine was evaluated. Results: confirmed decreased responsiveness progression. More importantly, able response immune-modulatory reagents, for example, arginine, readily manner, predicted reagents known mechanisms action. results tended parallel one another although some differences noted. Conclusion: offers unique assess status over time. presented herein demonstrate be used follow effects drugs ameliorate sepsis-induced dysfunction. This would major advance guiding new

Language: Английский

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The timing of death in burn patients

Acute Medicine & Surgery, Journal Year: 2024, Volume and Issue: 11(1)

Published: Jan. 1, 2024

Abstract Aim When treating burn patients, some patients die in the chronic phase, even if they overcome acute phase of burn. To elucidate timing death and its underlying causes among patients. Methods Patients evaluated were admitted to our center between January 2015, December 2019. Patient information, time, cause retrospectively collected from their medical records. Results Among 342 49 died. The time was as follows: within 24 h ( n = 9), 3 days 7), 1 week 5), 2 weeks 4), 3), 30 6), 60 after 9). hypoxic encephalopathy, extensive burns (>80%), severe heat stroke, coronary syndrome. sepsis, pneumonia, intestinal ischemia, pancreatitis, worsening diseases. mortality rate similar for ≥65 years age those with a area ≥20%, both groups showing particularly poor prognosis. Conclusions hospitalized showed bimodal distribution approximately 40% who survived resuscitation period died days. Elderly at high risk mortality. In care, treatment planning should consider not only short‐term but also long‐term

Language: Английский

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Multiple organ failure: What you need to know

Journal of Trauma and Acute Care Surgery, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 3, 2024

Multiple organ failure (MOF) remains a significant challenge for the acute care surgeon, often leading to poor patient outcomes. This comprehensive review explores etiology, pathophysiology, clinical presentation, diagnosis, management strategies, prognosis, and prevention strategies associated with MOF chronic critical illness. Understanding intricate etiology pathophysiology of illness is essential effectively managing these syndromes developing targeted treatment aimed at mitigating underlying inflammatory, immune, microvascular disturbances, in order redirect patients onto trajectory recovery.

Language: Английский

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