Paradigm of the injury-repair continuum during critical illness.

Abstract

To define injury and repair in the context of critical illness. Review of the literature. The medical practice of critical care medicine has long been one of aggressive assistance and support: utilizing state of the art technology to support the functions of the human body until homeostasis is again achieved and the patient is functioning sufficiently to allow the support to discontinue. Injury is defined as the disruption of molecular, cellular, or organ functions resulting from an external or internal stimulus. Repair is defined as an adaptive process that occurs in response to injury and involves both local and systemic responses that serve to restore structure and regulation for the purpose of organ/tissue function. The study of injury in critical illness is now occurring "upstream," at the genetic and cellular levels, to understand how damaging effects of acute inflammation from injury can be prevented or modulated. To treat the patient with critical illness more effectively, it is important to understand both the cause of the insults and the repair processes triggered by the insults because both processes affect the eventual course of the critical illness.