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Delirium is an under-reported condition that may affect up to 56% of older individuals after surgery, patients that have been heavily sedated for a length of time, burn, cancer, and patients on ventilators for long periods. Patients experience vivid hallucinations that may be part of a vicious cycle if doctors attempt to control the delusions with larger amounts of sedatives; the medications may disorient and confuse the patient even more.

The delusions and accompanying cognitive issues can persist for months after patients leave the hospital and can lead to a misdiagnosis of dementia, rather than delirium. [Dementia develops gradually and gradually worsens, while delirium may be of sudden onset.]

Delirium is associated with excessive inflammation in the brain resulting from triggering specialized immune cells the microglia. If stimulated over a long time, the cells release inflammatory cytokines, molecules that damage nerve cells and contribute to damage and break down of the capillaries in the brain, the blood-brain barrier.

C-reactive protein, CRP, is one measure of inflammation. CRP levels were measured in elderly surgical patients who had ended up with complications such as delirium, cardiovascular issues, or infection. The levels of CRP in their blood were predictive as to how fully they recovered.

A recent study measured the levels of 12 different inflammatory and anti-inflammatory cytokines in older patients undergoing surgery. Those having episodes of delirium had consistently high levels of inflammatory cytokines as compared to patients that did not have high levels of cytokines. Similar results were seen in patients that developed delirium after procedures such as open-heart surgery and hip fracture repair.

Conclusion

In order for the body to heal after it is hurt, or to fight an infection successfully, a delicate balance of cytokines, immune messages are required. Too little of an inflammatory response and the individual may not survive an infection. Too much of an inflammatory response and healthy tissue is destroyed. Homeostasis, balance, is what the body strives for every moment.

Dr. Hellen would be pleased to provide guidance to helping enhance your quality of life.  She may be contacted by using this form or at: 302.265.3870 (ET, USA).

 

www.theatlantic.com/health/archive/2015/06/the-overlooked-danger-of-delirium-in-hospitals/394829/
www.mayoclinic.org/diseases-conditions/delirium/basics/definition/con-20033982
www.ncbi.nlm.nih.gov/pmc/articles/PMC2911011
intl-biomedgerontology.oxfordjournals.org/content/early/2015/07/24/gerona.glv083.full
www.sciencedirect.com/science/article/pii/S2210833511000773
www.ncbi.nlm.nih.gov/pubmed/17504139

 

 

People with serious lung problems who are unable to breathe for themselves, for example, patients in intensive care units recovering from injuries, or who have viral, or bacterial infections, like pneumonia, may be placed on mechanical ventilation.

Although these patients may require a ventilator, too often these devices make their lung conditions worse. Patients with lung injuries that require mechanical ventilation lead to more deaths annually than do breast cancer and prostate cancer combined.

For years, scientists have known that when lungs are exposed to rhythmic pressure of ventilation, the production of cytokines, immune messengers, are stimulated.  This excessive production of cytokines results in “boosted”  levels of inflammation in the lungs that may damage the lungs, even after ventilation has been stopped. Excessive inflammation can lead to the destruction of formerly healthy organ systems.

It is as if the immune system sees “pressure” as a “foreign agent” an event against which the body much be protected.  The pressure appears to trigger an immune inflammatory response in the body.

This phenomenon can be seen even at the cellular level.  Exposing cells in a test tube to as few as four hours of rhythmic pressures results in increased levels of inflammatory cytokines that recruit more inflammatory immune cells into the area. Twelve (12) hours of ventilation-type treatment results in a 5-7 times increase in the levels of inflammatory cytokines.

During winter months, respiratory infections are the most frequent cause of intensive care unit hospitalizations for infants.  For some infections, Infants that are on mechanical ventilators have  significantly higher levels of lung inflammation than infants not being ventilated. However, even in healthy children, mechanical ventilation triggers an inflammatory response within hours.

 For over a decade I have tried to educate the public about the need for the body to maintain immune inflammatory homeostasis, immune balance; having enough inflammation to do the job, but not so much that it causes damage.

 Inflammation is necessary for our survival to protect us from infections, and it is the first step the body takes when it heals itself, for example, after an injury. 

But the amount of inflammation produced by the body must be tightly limited, because too much inflammation is like an uncontrollable forest fire.

One of my greatest frustrations has been trying to help medical practitioners understand that inappropriate inflammation is the foundation of most of their patients’ problems, but too often, “they just couldn’t get it”.  Now, every journal, every magazine touts the fact that “inflammation is the root cause of disease”.  They admit that it has a role in cardiovascular disease, gastrointestinal, emotional problems  etc. and that inflammatory responses play a major role in cancer.

It has been my experience that when individuals have major health issues, “following the levels of inflammation” will help explain what is happening to the patient.  In cases of mechanical ventilation, other procedures  and conditions, what would be the harm in taking steps to limit uncontrolled levels of inflammation, and help return the body to immune homeostasis?

 

Dr. Greenblatt looks forward to assisting you in returning to immune balance:  She can be contacted at: http://drhellengreenblatt.info/contact-dr-hellen or 1.302-265.3870 [USA, ET]. Thank you.

 

www.ncbi.nlm.nih.gov/pubmed/24349427
www.ncbi.nlm.nih.gov/pmc/articles/PMC3859624/
www.ncbi.nlm.nih.gov/pubmed/?term=Ghadiali+ventilators
researchnews.osu.edu/archive/lungvent.htm
www.fasebj.org/search?fulltext=Samir+Ghadiali&submit=yes&x=13&y=12
www.medicine.uiowa.edu/Newsarticle.aspx?id=22193
www.ncbi.nlm.nih.gov/books/NBK6868/
 

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