Occurrence of nervous system involvement in SIRS
Introduction
SIRS is a concept in which infection and several other clinical conditions induce a systemic inflammatory reaction affecting the microcirculation of all organs.
In 1991, The Society of Critical Care Medicine and The American College of Chest Physicians standardized definitions and recognized that severe systemic response could be evoked in the absence of infection [1]. When SIRS is associated with a documented infection, the term “sepsis” can be applied [2]. Furthermore, the terms “severe sepsis” and “septic shock” are reserved for patients with organ dysfunction and hypoperfusion or hypotension, despite adequate fluid replacement, and now are called multiple organ dysfunction syndrome (MODS). Recent review established working definitions and basis for a hypothesis-generating model [3].
This inflammatory response is largely mediated by cytokines which are released into the systemic circulation [2]. Probably there is an unbalance between pro- and anti-inflammatory reactions [4], [5].
During the past four decades, the medical treatment of critically ill patients has undergone dramatic and profound evolution that has been attributed to new surgical techniques, development of new antibiotics, improvement in hemodynamic monitoring capabilities, mechanical ventilation, and nutritional support.
The purpose of this study was to describe the neurological involvement in patients with SIRS in our university teaching hospital.
Section snippets
Patients
Between 1993 and 2003, we evaluated 68 patients with SIRS who were referred to us by treating physicians of the Critical Care Units (CCU) and Burned Critical Unit (BCU) of Hospital das Clínicas of Sao Paulo University School of Medicine. This longitudinal observational study was approved by the medical ethical committee of our hospital. All patients received the SIRS diagnosis in accordance with previous established criteria [1]. Respiratory function was supported by Bear 1000 respirator. Blood
Results
During the 10-year period, 68 patients with SIRS were evaluated. Four burned patients were excluded because neurological manifestation occurred after cardiac–respiratory arrest (encephalopathy in 2 and encephalopathy plus flaccid quadriplegia due to medular ischemia in 2). The clinical characteristics of 64 eligible patients showed 29 (45.3%) male and 35 (54.7%) female. Their age ranged from 16 to 95 years old; 61 were Caucasian, 2 Blacks and 1 Asian. The reasons for CCU or BCU admission were
Discussion
SIRS represents a pathophysiologic spectrum that results from a derangement between host inflammatory and immunosuppressive responses to an inciting event [4]. The pathophysiology of SIRS is complex and encompass risk factors and an initial pro-inflammatory environment that shift toward an anti-inflammatory state in the later stages. Age, gender, premorbid illness, genetic factors and site, type and extent of infection are risk factors in development of SIRS. Other conditions have also been
References (44)
- et al.
Sepsis and cytokines: current status
Br J Anaesth
(1996) - et al.
The systemic inflammatory response syndrome
Best Pract Res Clin Anaesthesiol
(2004) - et al.
Clinical and electrophysiological findings in critical illness polyneuropathy
J Neurol Sci
(1998) - et al.
Peripheral nerve function in sepsis and multiple organ failure
Chest
(1991) - et al.
Secondary organ dysfunction. From clinical perspectives to molecular mediators
Crit Care Clin
(1993) Myoclonus and its disorders
Neurol Clin
(2001)- et al.
Critical illness myopathy and neuropathy
Lancet
(1996) - et al.
Critical illness polyneuropathy and myopathy (CIPNM): evidence for local immune activation by cytokine-expression in muscle tissue
J Neuroimmunol
(2000) Sepsis and systemic inflammatory response syndrome: neuromuscular manifestations
Crit Care Med
(1996)- et al.
2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
Crit Care Med
(2003)
Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS)
Ann Intern Med
The neurological complications of sepsis
Ann Neurol
The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities
JAMA
Neuromuscular complications in patients given Pavulon (pancuronium bromide) during artificial ventilation
Clin Neurol Neurosurg
Myopathy in severe asthma
Am Rev Respir Dis
The Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis, and septic shock
Intensive Care Med
The natural history of systemic inflammatory response syndrome (sirs): a prospective study
JAMA
Risk factors for development of polyneuropathy and myopathy in critically ill patients
Crit Care Med
Epidemiology of sepsis syndrome in 8 Academic Medical Centers
JAMA
Difficult weaning
Intensive Care Med
The electroencephalogram in sepsis-associated encephalopathy
J Clin Neurophysiol
Early signs of critical illness polyneuropathy in ICU with systemic inflammatory response syndrome or sepsis
Intensive Care Med
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