ABSTRACT
The humoral and cell-mediated immune responses to tissue injury represent the first stages of repair, but if it is excessive local tissue injury may extend to a potentially lethal systemic inflammatory response syndrome (SIRS). In certain individuals a heterogeneous variety of insults, including trauma, haemorrhage, major surgery and ischaemia-reperfusion injury (IRI), may provoke an overwhelming inflammatory response ultimately leading to multiple organ dysfunction syndrome (MODS), organ failure and, ultimately, death. While the inflammatory response to tissue injury bears many similarities to the sepsis syndrome, a septic focus is not a prerequisite to SIRS. Paradoxically, when systemic inflammation becomes established, the essentially sterile IRI often exhibits a septic component which plays a crucial role in the propagation rather than the resolution of inflammation. In this chapter the pathophysiological processes involved in the evolution of SIRS and MODS in vascular patients are discussed.
