A STUDY FROM THE CELLULAR ASPECT ON THE PATHOPHYSIOLOGY AND TREATMENT OF MULTIPLE ORGAN FAILURE

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We have claimed that multiple organ failure (MOF) is the summation of the cellular injury in vital organs. Therefore therapeutic approaches to the MOF should be considered through the improvement of cellular dysfunction in the vital organs. For such approach the parameters which can express the severity of cellular injury is essential. The cellular injury score (CIS), which is derived from three different cellular metabolic sequences, arterial ketone body ratio (AKBR), serum osmolality gap and blood lactate and is proposed by us is found to be a good index to evaluate the severity of the patients with MOF. The impairment of cellular function following various insults such as sepsis, trauma, and shock can be caused through two mechanism: derangement in tissue oxygen metabolism and humoral mediators. Therefore for the treatment and/or prevention of cellular injury in the critically ill should be achieved through the improvement of tissue oxygen metabolism and the counter-measures for the humoral mediators. We have found that continuous hemofiltration (CHF)/continuous hemodiafiltration(CHDF) effectively remove the various humoral mediators and that those continuous blood purifications are also effective in the improvement of tissue oxygen metabolism following the administration of catecholamines. These results suggest that improvement of cellular dysfunction is an effective treatment/prophylaxis for MOF.