THE ROLE OF THE MICROCIRCULATION IN MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) - A REVIEW AND PERSPECTIVE

Major advances in intensive care medicine during the past two decades have altered the spectrum of disease encountered by intensive care phy sicians, anaesthesiologists, traumatologists and pathologists. One of the most important manifestations of severe trauma or infections is th e multiple organ dysfunction syndrome (MODS), a life-threatening condi tion that often ends in multiple organ failure (MOF) and death. Eviden ce gathered from clinical and morphological observations in humans, ta ken together with experimental animal studies and a vast accumulation of in vitro data, clearly indicate that the microcirculation lies at t he centre of this complex process, which results in peripheral vascula r insufficiency, inadequate oxygen delivery to vital organs, and hence , severe organ dysfunction. The multifunctional nature of the endothel ium makes it a prime candidate for study of the pathomechanisms of MOD S. This paper reviews the evidence for the hypothesis that the microci rculation, and in particular its endothelial component, has a central role in the pathogenesis of MODS. The evidence is reviewed principally from the standpoints of classical morbid anatomy and cell pathobiolog y.