Diagnosis and treatment of acute pulmonary inflammation in critically ill patients: The role of inflammatory biomarkers.

World J Crit Care Med 2019 Sep 11;8(5):59-71. Epub 2019 Sep 11.

Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, MN 55905, United States.

Pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit with a significant impact on morbidity, mortality and health care utilization despite early antimicrobial therapy and lung protective mechanical ventilation. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury. Adjunct anti-inflammatory treatment with corticosteroids is increasingly used, although the evidence for benefit is limited. The treatment decisions are based on radiographic, clinical and physiological variables without regards to inflammatory state. Current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyper-inflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications. Although many inflammatory biomarkers have been studied the most common and of interest are C-reactive protein, procalcitonin, and pro-inflammatory cytokines including interleukin 6. While extensively studied as prognostic tools (prognostic enrichment), limited data are available for the role of biomarkers in determining appropriate initiation, timing and dosing of adjunct anti-inflammatory treatment (predictive enrichment).

Download full-text PDF

Source
http://dx.doi.org/10.5492/wjccm.v8.i5.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753396PMC
September 2019
1 Read

Publication Analysis

Top Keywords

pulmonary inflammation
8
role biomarkers
8
inflammatory biomarkers
8
adjunct anti-inflammatory
8
acute pulmonary
8
anti-inflammatory treatment
8
therapeutic implications
4
inflammation response
4
characterized acute
4
entities characterized
4
implications inflammatory
4
prognostic therapeutic
4
response direct
4
lung injury
4
indirect lung
4
direct indirect
4
hypo-inflammatory prognostic
4
clinical entities
4
ventilation clinical
4
therapy lung
4

References

(Supplied by CrossRef)

Similar Publications