Key messages

• Multiple organ failure is often preceded by a systemic oxygen debt.

• The splanchnic region is susceptible to ischemia-reperfusion injury.

• Neutrophil activation in the ischemic gut mucosa results in remote organ injury.

• The systemic inflammatory response is both a cause and a consequence of cell injury.

• Systemic oxygen flux differs in the septic and non-septic state

• Multiple physiological insults potentiate each other

• Constitutional factors may determine individual susceptibility to multiple organ failure Introduction

The syndrome of multiple organ failure was first described in the mid-1970s ( Baue 1975). It is the most important reason for admission to intensive care, but it is also a result of sophisticated organ system support for patients who would previously have died rapidly from their acute disease. The mortality from multiple organ failure increases with the number and duration of failing organs ( Knaus eLal 1985), and the costs of death are high. The challenge for intensive care is to determine the pathogenesis of this diverse syndrome in order to prevent its development.

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