Although its roots date back to the early decades of the 20th century, critical care medicine did not emerge as a specialty in medicine until the 1970 s. Over the last 30 years or so, the field of critical care medicine has grown tremendously and there is now a solid body of scientific information that forms the foundation for the practice of critical care medicine. But, now as physicians and hospitals around the world focus to an ever greater extend on providing high quality care, the practice of critical care medicine will continue to grow in visibility and importance among clinicians and the general public as well.

This book seeks to identify the trends in critical care medicine that will form the basis for practice over the next ten years. Predicting the future is always risky. Nevertheless, the ideas articulated in this book are likely to serve as a road map for intensivists, hospital administrators and governmental leaders interested in healthcare, as they seek to improve the quality and efficiency of hospital-based services."

The pathophysiology of sepsis can be regarded as a series of steps, beginning with the invasion of normally sterile tissue by microbes and the elaboration of various pro-inflammatory mediators. The final common pathway is often the development of the multiple organ dysfunction syndrome (MODS). Whereas a great deal has been learned during the past quarter century about the inflammatory processes associated with sepsis (and other related conditions, such as ischemia/reperfusion injury), our understanding is far less developed with respect to the pathophysiological events that lead to organ dysfunction under these conditions. Nevertheless, efforts by both clinical and laboratory scientists are leading to new knowledge in this area. The chapters in this volume provide a state-of-the-art overview of many aspects of the pathophysiology of organ dysfunction in critical illness.

Researchers from many disciplines, with both basic and clinical perspectives, came together in this volume to review and debate issues pertaining to the investigation and control of tissue oxygenation in acute medicine, as well as treatments to improve tissue oxygenation when abnormal. In this latter context, special emphasis is placed on understanding the effect of blood substitutes on the circulation and on the potential roles of this family of compounds in clinical medicine.

The pathophysiology of sepsis can be regarded as a series of steps, beginning with the invasion of normally sterile tissue by microbes and the elaboration of various pro-inflammatory mediators. The final common pathway is often the development of the multiple organ dysfunction syndrome (MODS). Whereas a great deal has been learned during the past quarter century about the inflammatory processes associated with sepsis (and other related conditions, such as ischemia/reperfusion injury), our understanding is far less developed with respect to the pathophysiological events that lead to organ dysfunction under these conditions. Nevertheless, efforts by both clinical and laboratory scientists are leading to new knowledge in this area. The chapters in this volume provide a state-of-the-art overview of many aspects of the pathophysiology of organ dysfunction in critical illness.