Volume 2020, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426


Multiorgan dysfunction syndrome (MODS) remains a major complication and challenge to treat patients with critical illness in different intensive care unit settings. The exact mechanism and pathophysiology of MODS is complex and remains unexplored. We reviewed the literature from January 2011 to August 2019 to analyze the underlying mechanisms, prognostic factors, MODS scoring systems, organ systems dysfunctions, and the management of MODS. We used the search engines PubMed, MEDLINE, Scopus, and Google Scholar with the keywords “multiple organ dysfunction syndrome,” “intensive care units,” “multiorgan failure,” “MODS scoring system,” and “MODS management.” The initial search yielded 3550 abstracts, of which 91 articles were relevant to the scope of the present article. A better understanding of a disease course will help differentiate the signs of an intense inflammatory response from the early onset of sepsis and minimize the inappropriate use of medications. This, in turn, will promote organtargeted therapy and prevent occurrence and progression of MODS.


Article metrics loading...

Loading full text...

Full text loading...



  1. Dewar D, Moore FA, Moore EE, Balogh Z. Postinjury multiple organ failure. Injury. 2009 Sep;40(9):912–8. doi: 10.1016/j.injury.2009.05.024 .
  2. Ramírez M. Multiple organ dysfunction syndrome. Curr Probl Pediatr Adolesc Health Care. 2013 Nov-Dec;43(10):273–7. doi: 10.1016/j.cppeds.2013.10.003 .
  3. Marshall JC. The multiple organ dysfunction syndrome. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001.
  4. Maier B, Lefering R, Lehnert M, Laurer HL, Steudel WI, Neugebauer EA, et al. Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock. 2007 Dec;28(6):668–74.
  5. Sauaia A, Moore EE, Johnson JL, Ciesla DJ, Biffl WL, Banerjee A. Validation of postinjury multiple organ failure scores. Shock. 2009 May;31(5):438–47. doi: 10.1097/SHK.0b013e31818ba4c6 .
  6. Dharap SB, Ekhande SV. An observational study of incidence, risk factors & outcome of systemic inflammatory response & organ dysfunction following major trauma. Indian J Med Res. 2017 Sep;146(3):346–53. doi: 10.4103/ijmr.IJMR_1538_15 .
  7. Barie PS, Hydo LJ. Influence of multiple organ dysfunction syndrome on duration of critical illness and hospitalization. Arch Surg 1996;131:1318–24.
  8. Lobo SM, Rezende E, Knibel MF, Silva NB, Páramo JA, Nácul FE, et al. Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients. Anesth Analg. 2011 Apr;112(4):877–83. doi: 10.1213/ANE.0b013e3181e2bf8e .
  9. Dewar DC, Tarrant SM, King KL, Balogh ZJ. Changes in the epidemiology and prediction of multiple-organ failure after injury. J Trauma Acute Care Surg. 2013;74(3):774–9.
  10. Hutchings L, Watkinson P, Young JD, Willett K. Defining multiple organ failure after major trauma: A comparison of the Denver, Sequential Organ Failure Assessment, and Marshall scoring systems. J Trauma Acute Care Surg. 2017 Mar;82(3):534–41. doi: 10.1097/TA.0000000000001328 .
  11. Gu C, Qiao W, Wang L, Li M, Song K. Identification of genes and pathways associated with multiple organ dysfunction syndrome by microarray analysis. Mol Med Rep. 2018 Jul;18(1):31–40. doi: 10.3892/mmr.2018.8973 .
  12. Surbatovic M, Veljovic M, Jevdjic J, Popovic N, Djordjevic D, Radakovic S. Immunoinflammatory response in critically ill patients: severe sepsis and/or trauma. Mediators Inflamm. 2013;2013:362793. doi: 10.1155/2013/362793 .
  13. Morgan MP, Szakmany T, Power SG, Olaniyi P, Hall JE, Rowan K, et al. Sepsis patients with first and second-hit infections show different outcomes depending on the causative organism. Front Microbiol. 2016 Feb 26;7:207. doi: 10.3389/fmicb.2016.00207 .
  14. Moore FA, Sauaia A, Moore EE, Haenel JB, Burch JM, Lezotte DC. Postinjury multiple organ failure: a bimodal phenomenon. J Trauma. 1996 Apr;40(4):501–10; discussion 510-2.
  15. Ciesla DJ, Moore EE, Johnson JL, Sauaia A, Cothren CC, Moore JB, et al. Multiple organ dysfunction during resuscitation is not postinjury multiple organ failure. Arch Surg. 2004 Jun;139(6):590-4; discussion 594–5. doi: 10.1001/archsurg.139.6.590 .
  16. Rosenthal MD, Moore FA. Persistent inflammation, immunosuppression, and catabolism: evolution of multiple organ dysfunction. Surg Infect (Larchmt). 2016;17(2):167–72. doi: 10.1089/sur.2015.184 .
  17. Duran-Bedolla J, Montes de Oca-Sandoval MA, Saldaña-Navor V, Villalobos-Silva JA, Rodriguez MC, Rivas-Arancibia S. Sepsis, mitochondrial failure and multiple organ dysfunction. Clin Invest Med. 2014 Apr 1;37(2):E58–69.
  18. Spapen HD, Jacobs R, Honoré PM. Sepsis-induced multi-organ dysfunction syndrome—a mechanistic approach. J Emerg Crit Care Med. 2017;1:27. Available from: http://jeccm.amegroups.com/article/view/3844/4493 .
  19. Schulte W, Bernhagen J, Bucala R. Cytokines in sepsis: potent immunoregulators and potential therapeutic targets–an updated view. Mediators Inflamm. 2013;2013:165974. doi: 10.1155/2013/165974 .
  20. Gu C, Qiao W, Wang L, Li M, Song K. Identification of genes and pathways associated with multiple organ dysfunction syndrome by microarray analysis. Mol Med Rep. 2018 Jul;18(1):31–40. doi: 10.3892/mmr.2018.8973 .
  21. Rockey DC, Bell PD, Hill JA: Fibrosis-a common pathway to organ injury and failure. N Engl J Med. 372:1138–49. 2015.
  22. Karasu E, Nilsson B, Köhl J, Lambris JD, Huber-Lang M. Targeting complement pathways in polytrauma- and sepsis-induced multiple-organ dysfunction. Front Immunol. 2019 Mar 21;10:543. doi: 10.3389/fimmu.2019.00543 .
  23. Ciesla DJ, Moore EE, Johnson JL, Burch JM, Cothren CC, Sauaia A. The role of the lung in postinjury multiple organ failure. Surgery. 2005 Oct;138(4):749–57;discussion 757-8.
  24. Genga KR, Russell JA. Update of sepsis in the intensive care unit. J Innate Immun. 2017;9(5):441–55. doi: 10.1159/000477419 .
  25. Durham RM, Moran JJ, Mazuski JE, Shapiro MJ, Baue AE, Flint LM. Multiple organ failure in trauma patients. J Trauma. 2003 Oct;55(4):608–16.
  26. El-Menyar A, Al Thani H, Zakaria E, Zarour A, Tuma M, AbdulRahman H, et al. Multiple organ dysfunction syndrome (MODS): is it preventable or inevitable? Int J Clin Med 2012;3:722–30. Available from: http://dx.doi.org/10.4236/ijcm.2012.37A127 .
  27. Öz E, Saltürk C, Karakurt Z, Yazıcıoğlu Moçin Ö, Adıgüzel N, Güngör G, et al. Risk factors for multiorgan failure and mortality in severe sepsis patients who need intensive care unit follow-up. Tuberk Toraks. 2015 Sep;63(3):147–57.
  28. Fröhlich M, Lefering R, Probst C, Paffrath T, Schneider MM, Maegele M, et al.; Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society Sektion NIS. Epidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31,154 patients from the TraumaRegister DGU. J Trauma Acute Care Surg. 2014 Apr;76(4):921-7; discussion 927–8. doi: 10.1097/TA.0000000000000199 .
  29. Cryer HG, Leong K, McArthur DL, Demetriades D, Bongard FS, Fleming AW, et al. Multiple organ failure: by the time you predict it, it's already there. J Trauma. 1999 Apr;46(4):597–604; discussion 604-6.
  30. Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: a compendium. Indian J Crit Care Med. 2014 Apr;18(4):220–8. doi: 10.4103/0972-5229.130573 .
  31. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):762–74. doi: 10.1001/jama.2016.0288 .
  32. Sun D, Ding H, Zhao C, Li Y, Wang J, Yan J, et al. Value of SOFA, APACHE IV and SAPS II scoring systems in predicting short-term mortality in patients with acute myocarditis. Oncotarget. 2017 Jun 27;8(38):63073–83. doi: 10.18632/oncotarget.18634 .
  33. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995 Oct;23(10):1638-52.
  34. Fröhlich M, Wafaisade A, Mansuri A, Koenen P, Probst C, Maegele M, et al. Which score should be used for posttraumatic multiple organ failure? - Comparison of the MODS, Denver- and SOFA- Scores. Scand J Trauma Resusc EmergMed. 2016 Nov 3;24(1):130.
  35. Chen YX, Li CS. Risk stratification and prognostic performance of the predisposition, infection, response, and organ dysfunction (PIRO) scoring system in septic patients in the emergency department: a cohort study. Crit Care. 2014 Apr 16;18(2):R74. doi: 10.1186/cc13832 .
  36. Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA. 1993 Nov 24;270(20):2478–86.
  37. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993 Dec 22-29;270(24):2957–63.
  38. Maccariello ER, Valente C, Nogueira L, Ismael M, Valença RV, Machado JE, et al. Performance of six prognostic scores in critically ill patients receiving renal replacement therapy. Rev Bras Ter Intensiva. 2008;20(2):115–23.
  39. Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult intensive care units. Crit Care Clin. 2007;23:639–58.
  40. Comstedt P, Storgaard M, Lassen AT. The systemic inflammatory response syndrome (SIRS) in acutely hospitalised medical patients: a cohort study. Scand J Trauma Resusc Emerg Med. 2009 Dec 27;17:67. doi: 10.1186/1757-7241-17-67 .
  41. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008, 36:296–327.
  42. Pomara C, Riezzo I, Bello S, De Carlo D, Neri M, Turillazzi E. A pathophysiological insight into sepsis and its correlation with postmortem diagnosis. Mediat Inflamm. 2016. doi: 10.1155/2016/4062829 .
  43. Tsukamoto T, Chanthaphavong RS, Pape HC. Current theories on the pathophysiology of multiple organ failure after trauma. Injury. 2010;41(1):21–6. doi: 10.1016/j.injury.2009.07.010 .
  44. Chaudhry H, Zhou J, Zhong Y, Ali MM, McGuire F, Nagarkatti PS, et al. Role of cytokines as a double-edged sword in sepsis. In Vivo. 2013 Nov-Dec;27(6):669–84.
  45. Ince C, Mayeux PR, Nguyen T, Gomez H, Kellum JA, Ospina-Tascón GA, et al.; ADQI XIV Workgroup. The endothelium in sepsis. Shock. 2016 Mar;45(3):259–70. doi: 10.1097/SHK.0000000000000473 .
  46. Shapiro NI, Arnold R, Sherwin R, O'Connor J, Najarro G, Singh S, Lundy D, Nelson T, Trzeciak SW, Jones AE; Emergency Medicine Shock Research Network (EMShockNet). The association of near-infrared spectroscopy-derived tissue oxygenation measurements with sepsis syndromes, organ dysfunction and mortality in emergency department patients with sepsis. Crit Care. 2011;15(5):R223. doi: 10.1186/cc10463 .
  47. Fink MP. Cytopathic hypoxia. Mitochondrial dysfunction as mechanism contributing to organ dysfunction in sepsis. Crit Care Clin. 2001 Jan;17(1):219–37.
  48. Manson J, Cole E, De'Ath HD, Vulliamy P, Meier U, Pennington D, et al. Early changes within the lymphocyte population are associated with the development of multiple organ dysfunction syndrome in trauma patients. Crit Care. 2016 Jun 7;20(1):176. doi: 10.1186/s13054-016-1341-2 .
  49. Cabrera CP, Manson J, Shepherd JM, Torrance HD, Watson D, Longhi MP, et al. Signatures of inflammation and impending multiple organ dysfunction in the hyperacute phase of trauma: A prospective cohort study. PLoS Med. 2017 Jul 17;14(7):e1002352. doi: 10.1371/journal.pmed.1002352 .
  50. Marshall JC. Modeling MODS: what can be learned from animal models of the multiple-organ dysfunction syndrome? Intensive Care Med. 2005 May;31(5):605–8.
  51. Osterbur K, Mann FA, Kuroki K, DeClue A. Multiple organ dysfunction syndrome in humans and animals. J Vet Intern Med. 2014 Jul-Aug;28(4):1141-51. doi: 10.1111/jvim.12364 .
  52. Klingensmith NJ, Coopersmith CM. The gut as the motor of multiple organ dysfunction in critical illness. Crit Care Clin. 2016 Apr;32(2):203–12. doi: 10.1016/j.ccc.2015.11.004 .
  53. De Backer D, Orbegozo Cortes D, Donadello K, Vincent JL. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence. 2014 Jan 1;5(1):73–9. doi: 10.4161/viru.26482 .
  54. Kozlov AV, Lancaster JR Jr, Meszaros AT, Weidinger A. Mitochondria-meditated pathways of organ failure upon inflammation. Redox Biol. 2017 Oct;13:170–181. doi: 10.1016/j.redox.2017.05.017 .
  55. Ronco C, Ricci Z, Husain-Syed F. From multiple organ support therapy to extracorporeal organ support in critically ill patients. Blood Purif. 2019;48(2):99–105. doi: 10.1159/000490694 .
  56. Fredriksson K, Hammarqvist F, Strigård K, Hultenby K, Ljungqvist O, Wernerman J, et al. Derangements in mitochondrial metabolism in intercostal and leg muscle of critically ill patients with sepsis-induced multiple organ failure. Am J Physiol Endocrinol Metab. 2006 Nov;291(5):E1044-50.
  57. Pène F, Ait-Oufella H, Taccone FS, Monneret G, Sharshar T, Tamion F, et al.; Commission de Recherche Translationnelle de la Société de Réanimation de Langue Française (SRLF). Insights and limits of translational research in critical care medicine. Ann Intensive Care. 2015 Apr 30;5:8. doi: 10.1186/s13613-015-0050-3 .
  58. Fay KT, Ford ML, Coopersmith CM. The intestinal microenvironment in sepsis. Biochim Biophys Acta Mol Basis Dis. 2017 Oct;1863(10 Pt B):2574-2583. doi: 10.1016/j.bbadis.2017.03.005 .
  59. Condon M, Senthil M, Xu DZ, Mason L, Sheth SU, Spolarics Z, et al. Intravenous injection of mesenteric lymph produced during hemorrhagic shock decreases RBC deformability in the rat. J Trauma. 2011 Feb;70(2):489–95. doi: 10.1097/TA.0b013e31820329d8 .
  60. Deitch EA. Gut-origin sepsis: evolution of a concept. Surgeon. 2012 Dec;10(6):350–6. doi: 10.1016/j.surge.2012.03.003 .
  61. Diehl GE, Longman RS, Zhang JX, Breart B, Galan C, Cuesta A, et al. Microbiota restricts trafficking of bacteria to mesenteric lymph nodes by CX(3)CR1(hi) cells. Nature. 2013 Feb 7;494(7435):116–20. doi: 10.1038/nature11809 .
  62. Mayr VD, Dünser MW, Greil V, Jochberger S, Luckner G, Ulmer H, et al. Causes of death and determinants of outcome in critically ill patients. Crit Care. 2006;10(6):R154.
  63. Drosatos K, Lymperopoulos A, Kennel PJ, Pollak N, Schulze PC, Goldberg IJ. Pathophysiology of sepsis-related cardiac dysfunction: driven by inflammation, energy mismanagement, or both? Curr Heart Fail Rep. 2015 Apr;12(2):130–40. doi: 10.1007/s11897-014-0247-z .
  64. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J. 2012 Apr;33(7):895–903. doi: 10.1093/eurheartj/ehr351 .
  65. Romero-Bermejo FJ, Ruiz-Bailen M, Gil-Cebrian J, Huertos-Ranchal MJ. Sepsis-induced cardiomyopathy. Curr Cardiol Rev. 2011 Aug;7(3):163–83.
  66. Collard CD, Gelman S. Pathophysiology, clinical manifestations, and prevention of ischemia-reperfusion injury. Anesthesiology. 2001 Jun;94(6):1133–8.
  67. Schulte W, Bernhagen J, Bucala R. Cytokines in sepsis: potent immunoregulators and potential therapeutic targets—an updated view. Mediat Inflam. 2013. Available from: https://doi.org/10.1155/2013/165974 .
  68. Graziani M, Sarti P, Arese M, Magnifico MC, Badiani A, et al. Cardiovascular Mitochondrial dysfunction induced by cocaine: biomarkers and possible beneficial effects of modulators of oxidative stress. Oxid Med Cell Longev. 2017;2017:3034245. doi: 10.1155/2017/3034245 .
  69. Pollard S, Edwin SB, Alaniz C. Vasopressor and inotropic management of patients with septic shock. P T. 2015 Jul;40(7):438–50.
  70. Donati A, Carsetti A, Damiani E. The role of cardiac dysfunction in multiorgan dysfunction. Curr Opin Anaesthesiol. 2016 Apr;29(2):172–7. doi: 10.1097/ACO.0000000000000296 .
  71. Crimi E, Slutsky AS. Inflammation and the acute respiratory distress syndrome. Best Pract Res Clin Anaesthesiol. 2004 Sep;18(3):477–92.
  72. Cabrera-Benitez NE, Laffey JG, Parotto M, Spieth PM, Villar J, Zhang H, et al. Mechanical ventilation-associated lung fibrosis in acute respiratory distress syndrome: a significant contributor to poor outcome. Anesthesiology. 2014 Jul;121(1):189–98. doi: 10.1097/ALN.0000000000000264 .
  73. dos Santos CC, Slutsky AS. Protective ventilation of patients with acute respiratory distress syndrome. Crit Care. 2004 Jun;8(3):145–7.
  74. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301–8.
  75. Beitler JR, Malhotra A, Thompson BT. Ventilator-induced lung injury. Clin Chest Med. 2016 Dec;37(4):633–46. doi: 10.1016/j.ccm.2016.07.004 .
  76. Papathanassoglou ED, Moynihan JA, Ackerman MH. Does programmed cell death (apoptosis) play a role in the development of multiple organ dysfunction in critically ill patients? a review and a theoretical framework. Crit Care Med. 2000 Feb;28(2):537–49.
  77. Pavone LA, Albert S, Carney D, Gatto LA, Halter JM, Nieman GF. Injurious mechanical ventilation in the normal lung causes a progressive pathologic change in dynamic alveolar mechanics. Crit Care. 2007;11(3):R64.
  78. Husain-Syed F, Slutsky AS, Ronco C. Lung-kidney cross-talk in the critically ill patient. Am J Respir Crit Care Med. 2016 Aug 15;194(4):402–14. doi: 10.1164/rccm.201602-0420CP .
  79. Faubel S. Acute kidney injury and multiple organ dysfunction syndrome. Minerva Urol Nefrol. 2009 Sep;61(3):171–88.
  80. Yu D, Chen T, Cai Y, Zhao Z, Simmons D. Association between pulmonary function and renal function: findings from China and Australia. BMC Nephrol. 2017 May 1;18(1):143. doi: 10.1186/s12882-017-0565-y .
  81. Basu RK, Wheeler DS. Kidney-lung cross-talk and acute kidney injury. Pediatr Nephrol. 2013 Dec;28(12):2239–48. doi: 10.1007/s00467-012-2386-3 .
  82. Zhang Y, Wang L, Dey S, Alnaeeli M, Suresh S, Rogers H, et al. Erythropoietin action in stress response, tissue maintenance and metabolism. Int J Mol Sci. 2014 Jun 10;15(6):10296–333. doi: 10.3390/ijms150610296 .
  83. Kellum JA, Ronco C. Controversies in acute kidney injury: the 2011 Brussels Roundtable. Crit Care. 2011;15(2):155. doi: 10.1186/cc10118 .
  84. Zarbock A, Gomez H, Kellum JA. Sepsis-induced acute kidney injury revisited: pathophysiology, prevention and future therapies. Curr Opin Crit Care. 2014 Dec;20(6):588–95. doi: 10.1097/MCC.0000000000000153 .
  85. Holthoff JH, Wang Z, Seely KA, Gokden N, Mayeux PR. Resveratrol improves renal microcirculation, protects the tubular epithelium, and prolongs survival in a mouse model of sepsis-induced acute kidney injury. Kidney Int. 2012 Feb;81(4):370–8. doi: 10.1038/ki.2011.347 .
  86. Nesseler N, Launey Y, Aninat C, Morel F, Mallédant Y, Seguin P. Clinical review: the liver in sepsis. Crit Care. 2012 Oct 30;16(5):235. doi: 10.1186/cc11381 .
  87. Dhainaut JF, Marin N, Mignon A, Vinsonneau C. Hepatic response to sepsis: interaction between coagulation and inflammatory processes. Crit Care Med. 2001 Jul;29(7 Suppl):S42–7.
  88. Mizock BA. The multiple organ dysfunction syndrome. Dis Mon. 2009 Aug;55(8):476–526. doi: 10.1016/j.disamonth.2009.04.002 .
  89. Monard C, Rimmelé T, Ronco C. Extracorporeal blood purification therapies for sepsis. Blood Purif. 2019;47 Suppl 3:1–14. doi: 10.1159/000499520 .
  90. Balk RA. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit Care Clin. 2000 Apr;16(2):337–52.
  91. Lamb CM, MacGoey P, Navarro AP, Brooks AJ. Damage control surgery in the era of damage control resuscitation. Br J Anaesth. 2014 Aug;113(2):242–9. doi: 10.1093/bja/aeu233 .
  92. Hsu JM, Pham TN. Damage control in the injured patient. Int J Crit Illn Inj Sci. 2011 Jan;1(1):66–72. doi: 10.4103/2229-5151.79285 .
  93. Kalogeris T, Baines CP, Krenz M, Korthuis RJ. Ischemia/reperfusion. Compr Physiol. 2016 Dec 6;7(1):113–70. doi: 10.1002/cphy.c160006 .
  94. Bonanno FG. Clinical pathology of the shock syndromes. J Emerg Trauma Shock. 2011 Apr;4(2):233–43. doi: 10.4103/0974-2700.82211 .
  95. Sertaridou E, Papaioannou V, Kolios G, Pneumatikos I. Gut failure in critical care: old school versus new school. Ann Gastroenterol. 2015 Jul-Sep;28(3):309–22.
  96. Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev. 2001 Apr;14(2):244–69.
  97. Hotchkiss RS, Moldawer LL, Opal SM, Reinhart K, Turnbull IR, Vincent JL. Sepsis and septic shock. Nat Rev Dis Primers. 2016 Jun 30;2:16045. doi: 10.1038/nrdp.2016.45 .
  98. Funk DJ, Kumar A. Antimicrobial therapy for life-threatening infections: speed is life. Crit Care Clin. 2011 Jan;27(1):53–76. doi: 10.1016/j.ccc.2010.09.008 .

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error