الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cell death that is not apoptotic is common in critically ill patients, either from direct traumatic injury or from low-flow ischemic states, and almost always is clinically problematic. The immunologic response of critically ill patients can vary from a strongly proinflammatory response, characterized by increased production of tumor necrosis factor-alpha, interleukin (IL)-1, interferon (IFN)-gamma, and IL-12 to one predominantly of anergy, characterized by increased production of TH 2 cytokines, like IL-10 and to IL-4. The current study included 65 critically ill patients (35 males and 30 females), their age ranged from 1 months to 14 years, they were selected consecutively from patient admitted to Pediatric Intensive Care Unit of Mansoura University Children Hospital. It was concluded that: 1. Apoptosis plays an important role in critically ill patient, either as an etiological factor, progression of the course or as a line of treatment. As increase apoptosis in patient in heart failure may be responsible for progression of the disease and myocardial damage, while in ARDS, sepsis and MODS its decrease leads to release of various inflammatory mediators from neutrophil which may lead to uncontrolled inflammation. 2. TNF-? is an important inflammatory mediator serves as an in important etiological factor for all studied groups. And it level could be used as a predictor factor in cases of ARDS, sepsis and MODS. 3. ICAM-1 is an important adhesive molecules in the progression of the illness in all studied groups and could be used as a predictor factor for survival in ARDS, sepsis and MODS. 4. VCAM-1 also could be used as a predictor factor for survival in heart failure, ARDS, and MODS.