SEPSIS, SIRS, AND MODS - WHATS IN A NAME

Progress in the care of the critically ill patient with life-threateni ng infection has been hampered by inconsistent, often confusing termin ology. The clinical syndrome of sepsis-familiar to all yet definable b y none-describes a highly heterogeneous group of disorders with differ ent causes and differing prognoses. The imminent availability of media tor-directed therapy has created a sense of urgency to develop better methods for delineating discrete clinical syndromes and to modulate th e host response, which may bring both benefit and harm, depending on t he clinical circumstances. The term systemic inflammatory response syn drome (SIRS) nas introduced several gears ago to describe the familiar clinical syndrome of sepsis, independent of its cause, SIRS can resul t from trauma, pancreatitis, drug reactions, autoimmune disease, and a host of other disorders; when it arises in response to infection, sep sis is said to be present. SIPS describes a dynamic process that has a daptive survival value for the host. The maladaptive consequence of th is process in the critically ill patient is the development of progres sive hut potentially reversible remote organ dysfunction-the multiple organ dysfunction syndrome, The development of cogent conceptual frame works for classification of the septic response in critically ill pati ents is more than a question of linguistic pedantry, Optimal therapy p resupposes identification of an homogeneous patient population with a characteristic disease process and a predictable response to an interv ention. Although progress has been made in identifying such groups of critically ill patients, the disappointing results of clinical trials of agents that so clearly demonstrate efficacy in animal models indica tes that considerable work remains.