MOF, MODS, and SIRS: what is in a name or an acronym?

The most prominent contributions to multiple organ failure, multiple organ dysfunction syndrome, and systemic inflammatory response syndrome are described in this article. However, it is quite possible that there are others that have been missed. The problem of organ failure continues to perplex clinicians and scientists, and it contributes to fatal outcomes for patients with illnesses, infections, and injuries after operations. Although we know a fair bit about these problems, we frequently can do little about it. The best approach remains support to prevent failure.

From the experimental laboratory to the patient: how does it happen?

Many potential therapeutic agents or drugs are evaluated in experimental animal laboratories, but in spite of interesting effects, they infrequently come into common clinical use. The reasons for this are reviewed. Agents studied previously and many being studied now are cited. Perhaps the biggest benefit of study of drugs in animals (other than for safety and toxicity) is to help us better understand the pathophysiology of disease.

Important contributions to cardiothoracic surgery by Japanese thoracic and cardiac surgeons.

Cardiothoracic surgeons in Japan have made outstanding contributions to our knowledge and therapy of diseases and anomalies of the heart, lungs, esophagus, chest wall and diaphragm. It is an honor for me to address this subject at the 57th Annual Meeting of the Japanese Association for Thoracic Surgery in Sapporo because your President, Tomio Abe, is a valued friend and colleague who worked with me and my group as a Research Fellow at Washington U. from 1970-1973. He was recommended by Prof. Juro Wada, then the Chief in Sapporo. I was privileged to meet Prof. Wada at U.S. meetings. One of Prof. Wada's many contributions was the first cardiac transplant in Japan. Dr. Abe's work in St. Louis led to 12 publications and he was the first author of two papers. Since, his contributions expanded to more than 550 publications on treatment of complex congenital heart diseases, ventricular assistance, myocardial protection, valvular heart disease and aortic aneurysms. An operation for correction of Taussig-Bing malformation reported in 1984 is now referred to as the Abe operation. Torikata, in 1925, introduced "free thoracotomy" with no differential pressure. In 1933, Ohsawa successfully resected the esophagus with immediate reconstruction-the first in the world. Wada, in 1963, developed a thermodisc oxygenator and in 1966 the first tilting disc heart valve-the Wada Cutter Valve and other contributions as a worldwide ambassador for Japanese Surgery. Kawata, et al. showed better ventricular function after patch reconstruction of left ventricular aneurysms. Ueda, et al. revived retrograde cerebral perfusion for repair of aortic arch aneurysms. Nakayama, Akiyama and Isono made important contributions to esophageal cancer surgery. Kimoto, et al., in 1956, performed open cardiac surgery under direct vision with brain cooling by irrigation. Sakakibara, et al., Hikasa, et al., Atsumi, et al., and Takano and Akutsu made contributions to cardiac surgery. There were many other contributions by Japanese Surgeons.

Multiple organ failure in trauma patients.

SUMMARY: BACKGROUND As care of the critically ill patient has improved and definitions of organ failure have changed, it has been observed that the incidence of organ failure and the mortality associated with organ failure appear to be decreasing. In addition, many early studies included large heterogeneous populations of both medical and surgical patients that may have influenced the incidence and outcome of organ failure. The purpose of this study is to establish the current incidence and mortality of organ failure in a homogenous population of critically ill trauma patients. METHODS All trauma patients admitted to the intensive care unit (ICU) at an urban Level I trauma center were prospectively studied. Patients were evaluated for the presence of organ failure using definitions proposed by Knaus and by Fry. Newer definitions of organ failure incorporating organ dysfunction and severity-of-illness scores were also obtained in all patients in an attempt to predict outcome. These included lung injury scores (acute respiratory distress syndrome scores), Acute Physiology and Chronic Health Evaluation (APACHE) II and III scores, Injury Severity Score (ISS), and multiple organ dysfunction scores. Primary outcomes assessed were death and the occurrence of organ failure by the various definitions. RESULTS Eight hundred sixty-nine trauma patients were admitted to the ICU and survived longer than 48 hours. Mean APACHE II and APACHE III scores at admission to the ICU and ISS were 12.2 +/- 22, 30.5 +/- 22.7, and 19 +/- 10, respectively. Single organ failure (SOF) occurred in 163 patients (18.7%) and multiple organ failure occurred in 44 patients (5.1%). All SOF was caused by respiratory failure. Respiratory failure occurred first in the majority of patients with multiple organ failure. Mortality was 4.3% with one organ system failure, 32% with two, 67% with three, and 90% when four organ systems failed. None of the patients with SOF died secondary to respiratory failure. Multiple stepwise regression analysis was performed to determine which of the following risk factors are associated with the occurrence of organ failure: mechanism of injury, lactate at 24 hours, ISS, APACHE II, APACHE III, acute respiratory distress syndrome score at admission, multiple organ dysfunction score at admission and total blood products transfused in 24 hours. Of these factors, APACHE III, lactate at 24 hours, and total blood products transfused in 24 hours were associated with the occurrence of organ failure. CONCLUSION The overall incidence of organ failure in a homogeneous trauma population appears to be lower than that reported in studies performed in heterogeneous patient populations in the 1980s. Mortality for SOF is low and appears to be related primarily to the patient's underlying injuries and not to organ failure. Mortality for two or three organ system failures is lower than reported 15 to 20 years ago. Mortality for patients with four or more organ system failures remains high, approaching 100%.