Role of Neutrophils and Macrophages in Multiple Organ Failure

Abstract

In the late 1960s and early 1970s terms like “shock lung”, “Da Nang lung” and “Adult Respiratory Failure” became common in the literature and at rounds in the intensive care unit. Along with abnormalities in pulmonary function, there was renal failure and jaundice and a clinical syndrome was recognized which consisted of the following: persistent fever; tachycardia; high cardiac output associated with normal filling pressures and low peripheral resistance; tachypnea; requirement for ventilatory support; ileus; jaundice; necessity for dialysis. This clinical syndrome has come to be recognized and named Multiple Organ Failure (MOF). Subsequent to the initial report of MOF, it was suggested that the presence of MOF is indicative of occult sepsis which often leads to the recommendation for a laparotomy [1]. The precipitating factor(s) of MOF included shock, infection, massive trauma, burn injury and hematoma. MOF remains the predominant reason for both prolonged stay and death in the surgical intensive care unit. What was perceived as isolated organ failure, such as adult respiratory distress syndrome, is now seen as part of the systemic response to injury and repair. Sepsis has become the systemic inflammatory response due to invading microorganisms. What was once perceived as diagnostic of sepsis, has now been recognized after severe perfusion deficits and in the presence of continuing sources of dead and injured tissue.