Biomedical Engineering Reference
In-Depth Information
7.2
PHYSIOLOGIC FAILURE: MULTIPLE ORGAN
DYSFUNCTION SYNDROME
Timothy G. Buchman
Edison Professor of Surgery, Washington University School of Medicine,
St. Louis, Missouri
Functional integrity of complex organisms (including man) requires physiological adap-
tation to ordinary and extraordinary stress. When stress exceeds adaptive capacity, one or
more physiologic systems "fails"; without intervention, the organism dies. Clinical medi-
cine offers system-specific supports that have proven necessary but often insufficient to
promote recovery of function despite anatomic integrity and relief from the inciting
stress. Either the underlying relationships of the physiological adaptive systems have
been substantially altered or the depth of the basin of attraction described as multiple or-
gan dysfunction is sufficiently deep to make escape improbable using current organ sup-
port strategies. Experimental alternative organ system support strategies that emulate
healthy biological variability have accelerated recovery of dysfunctional organ systems.
1.
INTRODUCTION
Humans, like other life forms, can be viewed as thermodynamically open
systems that continuously consume energy to maintain stability in the internal
milieu in the face of ongoing environmental stress. In contrast to simple unicel-
lular life forms such as bacteria, higher life forms must maintain stability not
only in individual cells but also for the organism as a whole. To this end, a col-
lection of physiologic systems evolved to process foodstuffs; to acquire oxygen
Address correspondence to: Timothy G. Buchman, Washington University School of Medicine, 1
Barnes-Jewish Plaza, 6104 Queeny Tower, St. Louis, MO 63110 (buchman@msnotes.wustl.edu).
631
 
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