MULTIPLE ORGAN FAILURE - A COMMON PROBLEM IN SURGICAL INTENSIVE-CARE UNIT PATIENTS

The management of the surgical patient with multiple system organ fail ure remains a formidable problem. Despite advances in critical care, t he mortality of multiple organ failure remains unchanged since the syn drome was characterized almost two decades ago. At the present time th ere are no modalities that can actively reverse established organ fail ure, hence the treatment of these patients consists of metabolic and h aemodynamic support until the process reverses itself or death occurs. Therefore, the best management of the surgical patient at risk for mu ltiple organ failure is prevention of the syndrome. Strategies to avoi d organ failure include early fixation of long bone fractures, prompt restoration of perfusion and oxygen delivery, the aggressive diagnosis and drainage of abdominal infection prior to organ failure, early ins titution of enteral nutrition and the use of specific nutritional subs trates and formulas. This review will examine the current theories in the pathogenesis of multiple organ failure and detail two clinical dec isions, early stabilization of fractures and prompt re-exploration for suspected abdominal sepsis, that have been associated with a reductio n in the frequency of the development of organ failure.