ABSTRACT
The inflammatory and immune response to infection is a complex physiologic process targeted at removing foreign invaders, or pathogens, from the body. The initial inflammation that occurs may eliminate the pathogen, so that no infection results. If the inflammatory response is insufficient to remove the pathogen from the body, the acquired immune system becomes activated, stimulating the actions of T and B lymphocytes, which also attempt to eradicate the infectious pathogen. If this activity is successful, the body remains free of infection. If the pathogen remains viable in the body despite inflammatory and immune system actions, active infection ensues. The severity of the infection and the body's response depend on a multitude of factors including intactness of barrier defenses, immune competence of the host, virulence of the invading organism, and other underlying disease processes at work in the body. The critical care nurse must understand the inflammatory and immune responses to infection to appreciate the local and systematic effects of infection in the body and the rationale for treatment modalities.
Subject(s)
Infections/immunology , Inflammation/immunology , Humans , Immunity, Cellular/immunology , Inflammation Mediators/immunology , Leukocytes/immunology , Lymphocyte Activation/immunologyABSTRACT
Heart transplantation can be a lifesaving option for patients with end-stage heart failure. However, implanting recipients with an organ or tissue from a donor presents immunologic challenges. Sensitized recipients are at risk for hyperacute rejection because of the presence of preformed antibodies. Immune modulation with cyclophosphamide, plasmapheresis, and intravenous gamma globulin are methods used to desensitize transplant candidates with preformed anti-HLA antibodies to achieve successful transplantation.
Subject(s)
Graft Rejection/prevention & control , Heart Transplantation/adverse effects , Heart Transplantation/immunology , Preoperative Care/methods , Acute Disease , Adult , Cardiomyopathy, Dilated/complications , Cyclophosphamide/therapeutic use , Female , Graft Rejection/immunology , Graft Survival , HLA Antigens/immunology , Heart Failure/etiology , Heart Failure/surgery , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/therapeutic use , Mass Screening , Patient Selection , Plasmapheresis , Risk Factors , Transplantation ImmunologyABSTRACT
Repeat sternotomy for left ventricular assist device insertion may result in injury to the right heart or patent coronary grafts, complicating intraoperative and postoperative management. In 4 critically ill patients, left thoracotomy was used as an alternative to repeat sternotomy. Anastomosis of the outflow conduit to the descending thoracic aorta provided satisfactory hemodynamic support.
