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Related Experiment Videos

Multiple organ failure. How valid is the "two hit" model?

R Saadia1, M Schein

  • 1Department of Surgery, Baragwanath Hospital, Johannesburg, South Africa. roger.s@pixie.co.za

Journal of Accident & Emergency Medicine
|June 3, 1999
PubMed
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The "one hit" and "two hit" models explain multiple organ failure (MOF) in critically ill patients. However, these inflammatory models lack clinical and biological evidence, particularly regarding cytokine patterns, and should be critically evaluated.

Area of Science:

  • Critical Care Medicine
  • Trauma Surgery
  • Immunology

Background:

  • Proposed inflammatory "one hit" and "two hit" models aim to explain multiple organ failure (MOF) in trauma and surgical patients without infection.
  • These models suggest initial massive insults ("one hit") or subsequent minor events reactivating inflammation ("two hit") lead to MOF.
  • Clinical observations of initial recovery followed by organ dysfunction appear to support these models.

Purpose of the Study:

  • To critically evaluate the validity of the proposed "one hit" and "two hit" inflammatory models for multiple organ failure.
  • To assess the need for clinical and biological corroboration of these theoretical models.

Main Methods:

  • Review of existing literature on inflammatory models of MOF.
  • Analysis of clinical patterns and cellular mechanisms proposed by the "one hit" and "two hit" theories.

Related Experiment Videos

  • Emphasis on the requirement for cytokine secretion pattern data for validation.

    • Main Results:

    • The "one hit" and "two hit" models offer plausible explanations for MOF development in critically ill patients.
    • These models are mirrored at the cellular level with inflammatory cells being primed and reactivated.
    • Crucially, clinical and biological data, specifically cytokine patterns, are currently lacking to support these models.

    Conclusions:

    • The "one hit" and "two hit" inflammatory models for MOF are attractive due to apparent clinical correlations.
    • However, without robust evidence from cytokine secretion patterns, these models remain speculative.
    • Further research is needed to validate or refute the proposed inflammatory mechanisms in MOF.