Although many forms of critical illness are initiated by a proinflammatory stimulus, a compensatory anti-inflammatory response can occur with systemic inflammation. Immunoparalysis, an important form of acquired immunodeficiency, affects the innate and adaptive arms of the immune system. Immunoparalysis has been associated with increased risks for nosocomial infection and death in a variety of pediatric critical illnesses. Evidence suggests that immunoparalysis is reversible with immunostimulants. Highly standardized, prospective immune monitoring regimens are needed to better understand the immunologic effects of critical care treatment regimens and to enrich clinical trials with subjects most likely to benefit from immunostimulatory therapies.
Key points
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The proinflammatory surge that accompanies the onset of pediatric critical illness often occurs concurrently with a compensatory anti-inflammatory response.
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When severe and persistent, this anti-inflammatory response has been termed immunoparalysis and is associated with increased risks for nosocomial infection and mortality across a wide variety of pediatric intensive care unit (PICU) diagnoses.
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Immunoparalysis is quantifiable by tests that measure monocyte human leukocyte antigen (HLA)-DR expression, ex vivo stimulated cytokine production capacities, and cell counts.
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Promising therapies exist that have the potential to reverse immunoparalysis and improve outcomes in the PICU.
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Standardized immune monitoring regimens are needed to guide clinical management and inform enrollment into clinical trials aimed at restoring immune function in the PICU.
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