Patients with a heterogeneous trauma load and clinical picture are resuscitated into a similar state of systemic hyperinflammation, termed systemic inflammatory re- sponse syndrome (SIRS). This might be both beneficialand compensatory mechanism in the early stage of the disease, resolving in the majority of patients as they re- cover. However, organ failure may occur if this inflame- matory response is exaggerated or sustained, eventually resulting in MODS. The initial magnitude of postinjury inflammatory response is depend on the amount of tissue injury, the degree of shock and the presence of host fac- tors [4]. Patients who develop MODS frequently have early respiratory dysfunction, which is the major contribu- tor to early MODS, occurring in 99% of postinjury MODS. Lung dysfunction precedes cardiac, hepatic and renal dysfunction [1,5]. The other dysfunctional organ systems
can be associated with or without sepsis, and occur gene- rally after 72 hrs of the primary insult (Late MODS). Late MODS patients require a second hit to progress to organ failure, and this hit is often sepsis. Nosocomial pneumonia, a common ICU complication, is the major in- fection associated with or precipitate late MODS [1,6].