Bone Failure in Critical Illness
OBJECTIVES: The origin of systemic inflammatory response syndrome and multiple organ dysfunction syndrome is poorly understood but remains a fundamental concern in the ICU. This paper provides a critical appraisal on whether bone failure may represent an unrecognized component of systemic inflammatory response syndrome/multiple organ dysfunction syndrome. DATA SOURCES, DATA SELECTION, AND DATA EXTRACTION: Search of the PubMed database and manual review of selected articles investigating bone pathophysiology in critical illness. DATA SYNTHESIS: Bone hyperresorption is highly prevalent among critically ill patients. Bone breakdown releases numerous systemically active cytokines and bone-sequestered toxins, with the capacity to fuel inflammatory hypercytokinaemia and metabolic toxaemia. Anti-resorptive medication inhibits bone break down and preadmission anti-resorptive use is associated with superior survival among critically ill patients. CONCLUSIONS: We propose that hyperresorptive bone failure is an unrecognised component of systemic inflammatory response syndrome/multiple organ dysfunction syndrome that is causal to critical illness progression. If this hypothesis is valid, bone preservative strategies could reduce the risk of osteoporosis/fractures among ICU survivors, as well as decreasing critical illness mortality.
|ISBN||1530-0293 (Electronic) 0090-3493 (Linking)|
|Authors||Lee, P. ; Nair, P. ; Eisman, J. A. ; Center, J. R.;|
|Responsible Garvan Author|
|Publisher Name||CRITICAL CARE MEDICINE|
|URL link to publisher's version||http://www.ncbi.nlm.nih.gov/pubmed/27355524|
|OpenAccess link to author's accepted manuscript version||https://publications.gimr.garvan.org.au/open-access/13905|