Pediatric Critical Illness, Immunometabolism and Cardiovascular Risk: A Narrative Review

Area of Science:

• Critical care medicine
• Immunology
• Cardiovascular science

Background:

• Advances in critical care increase survival rates but lead to long-term sequelae like chronic critical illness (CCI) and post-intensive care syndrome (PICS).
• These syndromes involve persistent immune dysfunction and metabolic disturbances, impacting multiple organ systems.
• Unresolved inflammation following critical illness can lead to chronic cardiovascular disease (CVD).

Purpose of the Study:

• To explore the relationship between immune dysregulation and cardiovascular outcomes in critical illness survivors.
• To highlight the role of metabolic reprogramming and immune-mediated inflammation in recovery.
• To discuss the impact of specialized pro-resolving mediators (SPMs) in critical illness recovery.

Main Methods:

• Review of clinical and animal studies.
• Analysis of evidence linking acute critical illness to immune and cardiovascular sequelae.
• Exploration of mechanisms including metabolic shifts and inflammation resolution.

Main Results:

• Acute inflammatory insults can trigger sustained vascular inflammation and endothelial dysfunction, increasing CVD risk.
• Immune dysregulation and metabolic reprogramming are key factors in long-term cardiovascular complications.
• Failed inflammation resolution contributes to hypertension and atherosclerosis in survivors.

Conclusions:

• Critical illness survivors are at elevated risk for early-onset CVD due to persistent immune and metabolic alterations.
• Understanding these pathways is crucial for developing interventions to mitigate long-term cardiovascular risks.
• Targeting inflammation resolution and metabolic reprogramming may improve outcomes for critical illness survivors.