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Ann Thorac Surg 1996;61:1607-1608
© 1996 The Society of Thoracic Surgeons
Department of Cardiac Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, England
| The first 20% of the full text of this article appears below. |
Sirs: I have found you an argument. I am not obliged to find you an understanding. Dr Samuel Johnson (1709--1784)
Although Samuel Johnson's observation was addressed to his colleagues, not to SIRS (the acronym for the systemic inflammatory response syndrome), the point he makes is nonetheless relevant. Awareness of this aspect of cardiac surgery pathophysiology is increasing, but real understanding of the mechanisms involved is still sadly lacking. The article by Cremer and colleagues [1] published in this issue attempts to develop our understanding, focusing on the hemodynamic changes and the patterns of cytokine release that are features of this syndrome.
It is important to define what syndrome we are talking about. In 1991, a Consensus Conference convened by the Society of Critical Care Medicine and the American College of Chest Physicians produced the following definition of SIRS [2]: "The response to a variety of severe clinical insults (either infectious or non-infectious). The response is manifested by two or more of the following conditions
See also 1714.
The observant reader may note the breadth of this definition. Conditions leading to the response are "a variety of severe clinical insults." They may be infectious or noninfectious. The clinical features are similarly remarkably nonspecific; for example, the presence of pyrexia of more than 38°C and a moderate tachycardia are sufficient to include a patient in the syndrome.
The questions for us must surely be the following: Is cardiac
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Ann. Thorac. Surg. 1996 61: 1714-1720.
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