An uncontrolled primary disease process can result in secondary multisystem involvement (Fig 1), now known as the systemic inflammatory response syndrome

(SIRS) (Bone.eta/ 1992). This name replaces many older terms such as sepsis and sepsis syndrome (Table I)-

Fig. 1 Schematic representation of the development of multisystem involvement following a primary insult.

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Table 1 Criteria for the diagnosis of SIRS in adults.

SIRS occurs in many patients in intensive care units (ICUs). The underlying pathophysiology is decreased organ perfusion, which can involve whole organ systems or occur regionally within an organ system. Assessment of multisystem involvement can be confusing, showing a mixture of effects of increased and decreased regional blood flow. Furthermore, there is a temporal separation between the primary disease and involvement of other systems, and a range of severity of organ dysfunction.

Although the criteria for SIRS form a useful starting point, assessment of the severity of secondary multisystem involvement is undertaken by history, examination, and investigation of the patient, looking for evidence of individual organ dysfunction and determining the degree of dysfunction.

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