No unifying hypothesis yet found

The concept of multiple organ failure dates back to the 1970s,1 but it has recently been redefined as “the progressive (and sometimes sequential) dysfunction of physiologic systems in the presence of a clinical picture of systemic sepsis.”2 Multiple organ failure is often caused by the “systemic inflammatory response syndrome” (SIRS).3 A patient who has been severely injured and has survived initial resuscitation may develop the features of the systemic inflammatory response syndrome and may then deteriorate with features of multiple organ failure, which is often fatal. Despite an enormous amount of experimental and clinical research, a definitive, all encompassing theory accounting for the link between trauma and multiple organ failure has not yet emerged.

Twenty years ago few people doubted the link with infection. The belief was that trauma led to multiple organ failure as a result of unsuspected or uncontrolled infection, and an intra-abdominal abscess4 was most frequently incriminated as the trigger. The adverse clinical course usually started with the acute respiratory distress syndrome and led to the patient's death despite intensive system support. Based on these observations, an aggressive surgical policy …