The patient with multiple organ system failure: immunologic monitoring

The patient with multiple organ system failure is commonly suffering from the systemic effects of postsurgical or post-traumatic sepsis. An understanding of the role of the systems that mediate infection and produce much of the clinical picture is an important base for management and for future research. The use of the term "immunity" in relation to this process refers to two general response systems, which differ in some important aspects. The so-called cellular immune system, which embodies specific and preprogrammed responses, centers on the various populations of lymphocytes. Although there is considerable knowledge about their functional biology, this is perhaps more relevant to the transplantation and cancer areas than it is to trauma and surgical infection. Conversely, there is less known about the mediator systems, which seem to be more closely involved in the patient with multiple organ system failure. The relatively nonspecific responses of the circulating fixed macrophages, particularly granulocytes and monocytes, together with complement and other opsonins, clearly need considerable further investigation to define their critical role. This review attempts to outline common knowledge about the response systems that mediate systemic and organ failure in sepsis, and it points out certain areas that seem to hold promise for advances in the management of such patients.