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Intensive care medicine--a review.

Care of the critically ill patient has considerably changed over the last decades with advances in ventilatory support, antimicrobial therapy, inotropic drugs and improved renal support. The survival, however, of patients presenting with major trauma or sepsis and developing the syndrome of multiple organ failure (MOF) remains poor, although this may partially be due to more severely ill patients being admitted to the intensive therapy unit (ITU). In its final stages, shock, regardless of its primary pathogenesis, results in a picture of diffuse end-organ damage, coagulopathy, metabolic acidosis and hypotension. 'Septic shock', so called, is the commonest form of shock seen in hospitalized patients, and is the type of shock most studied in terms of pathogenetic mechanisms.