Critically ill patients are subject to several risk factors for organ
injury: surgical intervention,
trauma,
rhabdomyolysis, hemodynamic instability, organ hypoperfusion,
bacteremia and
endotoxemia,
sepsis and
septic shock. These conditions may cause
acute kidney injury (AKI), myocardial
dysfunction, liver failure, coagulation abnormalities,
acute lung injury (ALI),
adult respiratory distress syndrome (ARDS), bone marrow depression, loss of
acid/base homeostasis, and finally, brain dysfunction. The resulting picture of
multiple organ dysfunction syndrome (
MODS) is a lethal clinical entity that is refractory to all
therapies in the majority of cases. According to the "humoral theory of
sepsis", soluble substances circulate in blood and participate in the generation of the different disorders of
MODS; thus, AKI is not the only clinical disorder observed in intensive care unit (ICU) patients nor is it an isolated syndrome. Current extracorporeal management of such patients focuses mainly on
renal replacement therapy (RRT). Nevertheless, in recent years, technical evolution of extracorporeal devices led to the potential creation of multiple organ support
therapy (MOST) in order to provide a comprehensive replacement of multiorgan dysfunction: hence, other organs (liver, heart, lungs) and syndromes (abdominal
sepsis,
septic shock) can today be consistently supported and bridged. The technical advances of extracorporeal equipment, moreover, might allow today the design of a dedicated pediatric RRT device in order to treat patients below 10 kg, with the safety and adequacy standards that are currently granted to the adult population. This review will describe the technical evolution of MOST machines and current literature available on MOST.