Sepsis-associated delirium the pro and con of C5a blockade 英文参考文献.docVIP

Available online /content/13/2/135 Commentary Sepsis-associated delirium: the pro and con of C5a blockade Djillali Annane General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles SQY (UniverSud Paris), 104 boulevard Raymond Poincaré, 92380 Garches, France Corresponding author: Djillali Annane, Djillali.annane@rpc.aphp.fr Published: 22 April 2009 Critical Care 2009, 13:135 (doi:10.1186/cc7754) This article is online at /content/13/2/135 ? 2009 BioMed Central Ltd See related research by Flierl et al., /content/13/1/R12 Abstract study, C5a blockade almost fully blunted the pituitary response to caecal ligation and puncture-induced sepsis [1]. The intimate mechanisms of sepsis-induced delirium are unknown. Among the potential contributing factors, the breakdown of the blood–brain barrier is considered a key determinant of brain dysfunction. The complement activation is paramount to an appro- priate activation of the central nervous system during stress. C3a and C5a have been extensively studied and may be involved in sepsis-induced delirium. Here we discuss the pro and con for inhibiting C5a to attenuate brain damage during sepsis. In par- ticular, we discuss the hypothesis that C5a increased blood–brain barrier permeability amy ease the brain to mount an appropriate response to sepsis. Thus, blockade of C5a may be detrimental, resulting in an attenuated response of the stress system. The pro side for inhibition of C5a Adequate neuronal function requires a highly regulated extra- cellular environment, wherein the concentrations of ions such as sodium, potassium and calcium must be maintained within very narrow ranges. The brain accounts for approximately 20% of oxygen consumption in humans, and is also extremely sensitive to a wide range of chemicals that are circulating without harm to peripheral organ systems. It is ther