ABSTRACT

Intensive care units evolved during the two decades following World War II with the widespread introduction of technologies to support the function of failing organ systems: mechanical ventilation for the lungs, dialysis for the kidney, hemodynamic monitoring and pharmacologic therapy for the cardiovascular system, and total parenteral nutrition for the gut. Both clinical and animal studies suggest that multiple organ failure arises not so much from uncontrolled infection as from the septic response of the host; its mediators are endogenous and of host origin, rather than exogenous and of bacterial origin. The belief that factors arising from the gastrointestinal tract contribute to the systemic derangements associated with infection is an ancient one. Nutritional therapy directed at support of the gut and attenuation of the hepatic response holds promise as a means of minimizing the expression of the complex biologic cascade which culminates in the syndrome of multiple organ failure; its role in established multiple organ failure is less clear.