Management of the surgical patient with multiple system organ failure

The management of the surgical patient with multiple system organ failure (MSOF) remains a formidable problem. Despite advances in critical care, mortality from MSOF remains virtually unchanged since the syndrome was characterized almost two decades ago. At the present time, there are no modalities that can actively reverse established organ failure, hence the treatment of these patients consists of metabolic and hemodynamic support until the process reverses itself or until death. Therefore, the best management of the surgical patient at risk for MSOF is prevention of the syndrome. Strategies to avoid MSOF include early institution of enteral nutrition, the use of specific nutritional substrates and formulas, early fixation of long bone fractures, prompt restoration of perfusion and oxygen delivery, and the aggressive diagnosis and drainage of abdominal infection prior to organ failure. This review will focus on oxygen delivery, early stabilization of fractures, and prompt reexploration for suspected abdominal sepsis. (Nutritional therapy is discussed in another article in this supplement.) All of these inteventions have been associated with the prevention of MSOF and decreased mortality. In addition, future therapy using cytokines and monoclonal antibodies targeted for the prevention and treatment of MSOF will be examined.