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Anästhesiol Intensivmed Notfallmed Schmerzther 2024; 59(02): 96-112
DOI: 10.1055/a-2070-3516
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Das Immunsystem des kritisch Kranken

The Immune System of the Critically Ill Patient
Marie Vogeler
,
Judith Schenz
,
Eckhard Müller
,
Markus Weigand
,
Dania Fischer
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Bei einer Immundysfunktion kritisch Kranker gibt es nur begrenzte therapeutische Möglichkeiten und bei Persistenz ist sie mit einer hohen Sterblichkeit assoziiert. Das Immunsystem ist das potenteste Antiinfektivum des Menschen – so ist die Kenntnis inflammatorischer Reaktionsmuster, der Besonderheiten in Prophylaxe und Therapie von Sekundärinfektionen und möglicher Therapieoptionen zur Restitution des Immunsystems hochrelevant.

Abstract

Critically ill patients often experience a dysregulated immune response, leading to immune dysfunction. Sepsis, trauma, severe infections, and certain medical conditions can trigger a state of systemic inflammation, known as the cytokine storm. This hyperactive immune response can cause collateral damage to healthy tissues and organs, exacerbating the patient’s condition. On the other hand, some critically ill patients may suffer from immune paralysis which can increase the risk of nosocomial infections.

Fever is an evolutionary adaptation that evolved as an effective defense mechanism to fight invading pathogens. By raising body temperature, fever enhances the immune response, inhibits pathogen growth, promotes recovery, and aids in the formation of immune memory. Understanding the role of fever in the context of immune defense is crucial for optimizing medical interventions and supporting the body’s natural ability to combat infections.

Future Directions: Advancements in immunology research and technology hold promise for better understanding the immune system’s complexities in critically ill patients. Personalized medicine approaches may be developed to tailor therapies to individual patients based on their immune profile, optimizing treatment outcomes. Based on recent studies prognostic parameters such as lymphocyte count, IL-10 concentration and mHLA-DR expression can be used to stratify the immunological response pattern in septic patients.

Conclusion: The immune system’s response in critically ill patients is a multifaceted process, involving intricate interactions between various immune cells, cytokines, and organs. Striking the delicate balance between immune activation and suppression remains a significant challenge in clinical practice. Continued research and therapeutic innovations are vital to improve patient outcomes and reduce the burden of critical illness on healthcare systems.

Kernaussagen

  • Prognostische Parameter wie die Lymphozytenzahl, die IL-10-Konzentration und die mHLA-DR-Expression können zur Stratifizierung der immunologischen Reaktionsmuster bei septischen Patienten genutzt werden.

  • Eine möglicherweise gegensätzliche immunologische Reaktion bezüglich verschiedener Kompartimente sollte beachtet werden.

  • Diagnostische und therapeutische Maßnahmen beeinflussen das Immunsystem unserer Patienten relevant.

  • Eine Kühlung fiebernder Patienten sollte nur in begründeten Ausnahmen erfolgen.

  • Zeigt ein Patient auch im postakuten Verlauf Hinweise auf eine persistierende immunsuppressive Dysregulation (z. B. Lymphopenie, erniedrigte mHLA-DR-Werte) in Zusammenhang mit wiederkehrenden opportunistischen Infektionen, ist es wichtig, dass die entsprechende Prognose früh thematisiert wird und supportive Behandlungsoptionen gemeinsam mit dem Patienten und dessen Angehörigen besprochen werden.

Schlüsselwörter

kritische Erkrankung - Sepsis - Immunoseneszenz - Fieber - Sekundärinfektionen

Keywords

critical illness - sepsis - immune senescence - fever - immunosuppression


Publication History

Article published online:
14 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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