MULTIPLE ORGAN FAILURE SYNDROME IN THE 1990S - SYSTEMIC INFLAMMATORY RESPONSE AND ORGAN DYSFUNCTION

Objective.-This review of the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) provides an over view of a common but complex problem found in critically ill patients. It emphasizes definitions, common clinical patterns, metabolic respon ses, and pathophysiological changes. A brief discussion of treatment c oncepts is also included. Data Sources.-Data for this review were gath ered from peer-reviewed journals, review articles by experts in SIRS/M ODS, and selections from reference volumes written on SIRS/MODS. Study Selection.-Reference selections were chosen on the basis of quality o f research. Peer-reviewed journals were given primary consideration. T hose review articles cited were felt to be essential to any discussion of SIRS/MODS. Data Extraction.-Where possible, randomized, controlled , prospective studies were reviewed and conclusions used in this overv iew of SIRS/MODS. Conclusion.-Our ability to care for critically ill p atients has led to a new problem, SIRS and eventually MODS, which may become progressive organ failure and death. Unfortunately, these condi tions are extremely frequent and carry high mortality rates. Increased oxygen consumption demands highlight the physiological response. The typical metabolic responses are characterized by hyperglycemia and acc elerated protein catabolism. Unrecognized perfusion deficits, an uncon trolled septic focus, a persistent source of inflammation, or injured tissue is commonly present with SIRS/MODS and should be corrected. Res toration of oxygen transport and metabolic support are also important components of treatment. The cause of SIRS/MODS is complex and not ful ly understood, but multiple mediators and stimulated macrophages likel y are important components and areas where treatment may well be focus ed.