Cascade system activation in shock.

Trauma and sepsis activate different cascade systems. Activation of the coagulation and clotting systems, of the kinin-kallikrein system and of the complement system are important etiological mechanisms behind development of the adult respiratory distress syndrome (ARDS) and multisystem organ failure (MOF) after extensive trauma or severe septic situations. Activation of complement with the release of anaphylatoxins and terminal complement complexes is associated with increased mortality and development of ARDS and MOF after major surgery and in situations of septic shock. The anaphylatoxins have potent vascular properties and they activate leukocytes. Their effects on the leukocytes lead to the release of free oxygen radicals, different lysosomal enzymes and cytokines, leukotrienes and histamine. All these inflammatory mediators may, if released in extensive amounts, induce microvascular injury and interstitial edema. If this process takes place in the lung, ARDS may develop and if other organs, i.e the liver and the kidneys, are involved, MOF may be the result.