Multiple physiological insults

Another important finding is that combined or sequential physiological insults produce more injury than a single insult. In animal models, gut ischemia-reperfusion causes pulmonary leak and neutrophil sequestration but little morbidity or mortality; independently, the injection of a low dose of endotoxin causes neutrophil sequestration but no leak. However, the same dose of endotoxin given after reperfusion results in acute lung injury and a high mortality. This type of pattern is much more typical of the clinical situation, where relatively minor disturbances of physiology, many of them iatrogenic, may occur repeatedly following a major precipitant such as trauma, surgery, or cardiopulmonary arrest.

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