Prevention of multiple organ failure.
Physicians are still largely ignorant of the underlying biology of SIRS and multiple organ failure. Nonetheless, strategies to prevent multiple organ failure are possible. These include aggressive resuscitation of hemodynamically unstable patients, careful assessment to avoid missing clinically significant injuries, early operative treatment of all possible injuries with debridement of all nonviable tissue, early nutritional support, and the early diagnosis and prompt treatment of infectious complications. Treatment of patients with established multiple organ failure is still largely supportive and has made little impact on the patient mortality rate over the past 20 years. Future treatment strategies must focus on multimodality combination therapy aimed at specifically suppressing excessive activation of the inflammatory response while preserving immune competence and normal antimicrobial defenses. Only then are physicians likely to begin to see a reduction in the mortality rate of patients with this complex and challenging condition.
Deitch
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Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA. edeitch@umdnj.edu
Goodman
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D003131:Combined Modality Therapy; D003646:Debridement; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007121:Immunocompetence; D009102:Multiple Organ Failure / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D018529:Nutritional Support; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy; D012769:Shock / Q000628:therapy; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D014947:Wounds and Injuries / Q000601:surgery