title: Presidential address: imagination trumps knowledge.
abstract: Multiple organ failure (MOF) emerged 30 years ago and became our research focus. Over the years, we have proposed a series of cartoons that rallied multidisciplinary translational research teams around common themes to generate "win-win" hypotheses that when tested (right or wrong) have advanced our understanding of MOF. MOF has a bimodal trajectory, and the gut plays a role in both trajectories. Early MOF occurs because of excessive proinflammation (ie, systemic inflammatory response syndrome [SIRS]), and early gut ischemia-reperfusion can amplify SIRS and contribute to the early fulminant SIRS-MOF trajectory. Fortunately, most patients survive early SIRS, but some develop excessive anti-inflammation (ie, compensatory anti-inflammatory response syndrome). The gut also plays a role in this late indolent compensatory anti-inflammatory response syndrome-MOF trajectory. Multiple factors cause progressive gut dysfunction such that the gut (an important immunologic organ) worsens compensatory anti-inflammatory response syndrome and becomes the reservoir for pathogens and toxins that cause late sepsis.
authors.affiliation: Division of Surgical Critical Care and Acute Care Surgery, Department of Surgery, The Methodist Hospital, Houston, TX, USA. famoore@tmhs.org
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
mesh_terms: D000818:Animals; D004750:Enteral Nutrition; D041981:Gastrointestinal Tract / Q000503:physiopathology*; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000503:physiopathology; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000503:physiopathology; D057170:Translational Research, Biomedical