Abstract
Multiple organ dysfunction syndrome (MODS) is a leading cause of death in the ICU. Protracted inflammation, generally triggered by sepsis, is its most prominent feature. Acute lung injury and acute respiratory distress syndrome (ALI/ARDS), a severe respiratory failure produced by an inflammatory, permeability-mediated pulmonary oedema, is strongly related to MODS, given that both disorders may appear simultaneously, or each precede the other. Inflammation pathways are intensely activated in both entities. Theories about MODS origin are presented: the lack of a compensatory antinflammatory response that usually limits ongoing injury, and the alteration of the intestinal barrier, which could allow dissemination of bacteria and/or proinflammatory mediators towards distant sites of the organism. Lastly, the two final pathogenic mechanisms of organ dysfunction are discussed: microcirculatory alterations that could lead to redistribution of blood flow and subsequent hypoperfusion; and cytopathic hypoxia, which points to direct, reversible damage of intracellular metabolic mechanism.
| Abbreviations | ||
| ALI | = | acute lung injury |
| ARDS | = | acute respiratory distress syndrome |
| CARS | = | compensatory anti-inflammatory response |
| Fio2 | = | inspirational oxygen fraction |
| ICU | = | intensive care unit |
| IFN-γ | = | γ-interferon |
| IL | = | interleukin |
| iNOs | = | inducible nitrous oxygen synthase |
| MODS | = | multiple organ dysfunction syndrome |
| NO | = | nitric oxide |
| ONOO− | = | peroxynitrite |
| Pao2 | = | arterial oxygen tension |
| PARP | = | poly(ADP-ribosyl)polymerase |
| SIRS | = | systemic inflammatory response syndrome |
| TNF-α | = | tumour necrosis factor-α |
| VILI | = | ventilator-induced lung injury |
| Abbreviations | ||
| ALI | = | acute lung injury |
| ARDS | = | acute respiratory distress syndrome |
| CARS | = | compensatory anti-inflammatory response |
| Fio2 | = | inspirational oxygen fraction |
| ICU | = | intensive care unit |
| IFN-γ | = | γ-interferon |
| IL | = | interleukin |
| iNOs | = | inducible nitrous oxygen synthase |
| MODS | = | multiple organ dysfunction syndrome |
| NO | = | nitric oxide |
| ONOO− | = | peroxynitrite |
| Pao2 | = | arterial oxygen tension |
| PARP | = | poly(ADP-ribosyl)polymerase |
| SIRS | = | systemic inflammatory response syndrome |
| TNF-α | = | tumour necrosis factor-α |
| VILI | = | ventilator-induced lung injury |