Splanchnic ischaemia/reperfusion and multiple organ failure

Abstract

failure was blamed for over 50 % of later fatalities [127]. Basic scientific investigations supported the addition of crystalloid solutions to blood transfusions. More vigorous fluid resuscitation during the Vietnam War led to a 20- to 30-fold reduction in the incidence of renal failure compared with the Korean experience. However, a new problem came to the forefront in Vietnam: “shock lung”—the acute respiratory distress syndrome (ARDS) [8]. Of note, in accounts of the Korean conflict, there was virtually no mention of pulmonary problems. Advances in respiratory care, and particularly in mechanical ventilation, allowed more patients to survive ARDS. Today, while our ability to sustain patients on mechanical ventilation has improved, the number of patients dying with ARDS remains high; this is because the actual cause of death has shifted to MOF. The identification of MOF as a distinct entity dates back to 1973, when Tilney, Bailey and Morgan [128] described the progressive failure of organ systems in patients following repair of ruptured abdominal aortic aneurysms. Baue [15] first suggested there was a sequential pattern to the MOF syndrome. In 1977, Eiseman, Beart and Norton [40] at our institution described its clinical presentation and coined the term “multiple organ failure”. Since that time, intensive research efforts have targeted the syndrome.