Key messages

• The majority of deaths in patients who have been critically ill for more than 7 days are associated with sepsis.

• Critical illness is associated with multiple defects in immune function which reduce the capacity to fight infection.

• Immune dysfunction can be related both to excess production of proinflammatory mediators and, at other times, to overproduction of endogenous anti-inflammatory agents.

• Cytokines are not the only soluble factors implicated in the generation of immune dysfunction; eicosanoids, reactive oxygen intermediates, heat shock proteins, and acute phase reactants are also important.

• Hormonal, nutritional, and genetic factors, as well as associated organ failures (renal—uremia; gut—endotoxin/translocation; respiratory—hypoxia) and drugs, all contribute to impairment of normal immune function in critically ill patients.

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