Multiple organ dysfunction syndrome: exploring the paradigm of complex nonlinear systems.
OBJECTIVE
The objectives of this article are to introduce and explore a novel paradigm based on complex nonlinear systems, and to evaluate its application to critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS).


METHODS
Published original work, review articles, scientific abstracts and books, as well as our personal files.


METHODS
Studies were selected for their relevance to the applications of nonlinear complex systems, to critical care medicine, and to the concepts presented.


METHODS
We extracted all applicable data.


RESULTS
Following a brief review of MODS, an introduction to complex nonlinear systems is presented, including clear concepts, definitions, and properties. By examining the multiple, nonlinear, interrelated, and variable interactions between the metabolic, neural, endocrine, immune, and inflammatory systems; data regarding interconnected antibody networks; and the redundant, nonlinear, interdependent nature of the inflammatory response, we present the hypothesis that the systemic host response to trauma, shock, or sepsis must be evaluated as a complex nonlinear system. This model provides a new explanation for the failure of trials using various antimediator therapies in the treatment of patients with sepsis and MODS. Understanding the host response as a complex nonlinear system offers innovative means of studying critical care patients, specifically by suggesting a greater focus on systemic properties. We hypothesize that analysis of variability and connectivity of individual variables offer a novel means of evaluating and differentiating the systemic properties of a complex nonlinear system. Current applications of evaluating variability and connectivity are discussed, and insights regarding future research are offered.


CONCLUSIONS
The paradigm offered by the study of complex nonlinear systems suggests new insights to pursue research to evaluate, monitor, and treat patients with MODS.
Department of General Surgery, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada.
A J
AJ
Seely
N V
NV
Christou
D003422:Critical Care / Q000379:methods / Q000639:trends; D006339:Heart Rate; D006801:Humans; D009102:Multiple Organ Failure / Q000276:immunology / Q000378:metabolism / Q000628:therapy; D017711:Nonlinear Dynamics