From Celsus to Galen to Bone: The Illnesses, Syndromes, and Diseases of Acute Inflammation
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The evolution of intensive care has given rise to a unique challenge in medical taxonomy — to describe and characterize the course of diseases that have no biologic precedent. Intensivists debate the optimal definition of such common disorders as sepsis, the acute respiratory distress syndrome (ARDS), and multiple organ failure (MOF),but the roots of this debate he less in the inherent biologic vagaries of the individual processes than in the fact that they are, at root, iatrogenic creations. Acute lung injury only develops in patients whose death has been forestalled by the mechanical ventilator, while the profound physiologic derangements of overwhelming infection are rapidly lethal in the absence of fluid resuscitation, anti-infective therapy, and the spectrum of supportive measures that the contemporary intensive care unit (ICU) provides. The concept of the multiple organ dysfunction syndrome (MODS) reflects an implicit acceptance that the course of critical illness is defined more by what we as physicians have done to sustain the patient, than by the natural history of the extrinsic clinical disorders that rendered the patient critically ill.
KeywordsAcute Lung Injury Systemic Inflammation Acute Respiratory Distress Syndrome Critical Illness Multiple Organ Dysfunction Syndrome
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