Advances in the understanding of multiple organ failure

Multiple organ failure (MOF) is currently the most common cause of late death after injury and surgery. The pathogenesis of MOF remains incompletely understood but in all likelihood results from a combination of dysregulated balance between inflammatory response and immune function, maldistribution of microcirculatory blood flow, and ischemia/reperfusion injury. Advances in the understanding of the pathogenesis of MOF have been hampered by a lack of precise animal models, accurate definitions of disease, consistent means to qualitatively and quantitatively diagnose disease, and a definable at-risk group of patients for study. Several recent advances in critical care and proposed new therapies hold promise for improving the outcome of patients with multiple injuries who are at risk for MOF. However, as recent clinical trials have shown, studies demonstrating an improvement in outcome from use of these therapeutic agents are difficult to design. The purpose of this article is to discuss the evolution, clinical course, and pathogenesis of MOF, to attempt to better define and quantitate MOF, and to describe recent studies aimed at identifying an at-risk study population for improved treatment and prevention strategies for MOF.