Systemic inflammationmultiorgan failure

Exposure to an exogenous insult can result in an exaggerated, generalised and often inappropriate inflammatory response. This is described as 'SIRS'—the systemic inflammatory response syndrome. Stimulation of inflammatory pathways leads to activation of macrophages, endothelium, neutrophils, platelets, coagulation, fibrinolytic and contact systems with release of inflammatory mediators and effectors (e.g. cytokines, prostanoids, free oxygen radicals, proteases, nitric oxide, endothelin). This results in microvascular obstruction and occlusion, blood flow redistribution, interstitial oedema and fibrosis, and cellular mitochondrial dysfunction. The consequences of this may be organ dysfunction, varying from 'mild' to severe, and affecting single or multiple organs, resulting in cardiovascular collapse, gastrointestinal failure, renal failure, hepatic failure, encephalopathy, neuropathy, myopathy, and/or disseminated intravascular coagulation. Acute respiratory distress syndrome (ARDS) is the respiratory component of this pathophysiological response.

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