The Hypermetabolism: Multiple Organ Failure Syndrome

Abstract

The syndrome of multiple organ failure (MOFS) has become recognized as a clinical entity only in the past ten to 20 years, primarily as a result of advances in technology, medical information, and scientific research that have allowed the successful treatment of single organ failures. Unfortunately, modern warfare has been the impetus for many of these medical advances. World War I led to the concepts of fracture immobilization and shock resuscitation. With World War II came blood banking and an emphasis on early evacuation and operative treatment of battlefield casualties. As early mortality rates from hemorrhage improved, survivors came to be at risk for late complications, and in the Korean War, acute renal failure became one of the leading causes of death. While early fluid resuscitation, with rapid evacuation and definitive operative treatment, reduced the incidence of acute renal failure, the Vietnam War introduced a new complication of shock, the adult respiratory distress syndrome (ARDS). Initially thought to be a result of overzealous fluid administration, it became clear that ARDS was actually a complication of circulatory shock, infection, and tissue injury in nonlung areas of the body. By the mid 1970s it became increasingly clear that the pathophysiology of ARDS was not confined to the lung but is part of a systemic injury-response pattern now known as the hypermetabolism-organ failure syndrome.