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When the human body is injured, its immunological defence mechanisms may be so injured or altered that they can no longer prevent multiple organ failure. The sequence of events leading from injury to impaired defence response to multiple organ dysfunction syndrome are reviewed here. First, basic mechanisms are discussed - the crucial alterations of immune and inflammatory mechanisms, the role of endotoxin and potential counterregulatory strategies to neutralize endotoxin in order to prevent shock, major etiological factors leading to organ failure, and cytokines and the modulation of cytokine action. In the discussion of the clinical aspects of multiple organ failure, the antibiotic interactions with host defenses, the augmentation of immunoreactivity with special nutrients and the newest insights into the regulation of wound repair are elucidated. The final sections of the book deal with therapeutic immunomodulatory approaches for the prevention of infections and with interventional strategies in the therapy of septic shock.

Host Defense Dysfunction in Trauma, Shock and Sepsis