Are mitochondria responsible for improved outcomes in recent studies?

The Acute Respiratory Distress Syndrome Network (ARDSnet) group compared low tidal volume ventilation with standard ventilatory strategies [1]; early goal directed therapy (EGDT) advocated administering fluids, blood products, and dobutamine to achieve oxygen delivery goals to septic patients on arrival in the emergency department [2]; and intensive insulin therapy was used to maintain tight glucose parameters in surgical patients [3]. These are landmark but disparate trials that have demonstrated major improvements in outcome and feature in the Surviving Sepsis Campaign Guidelines for managing sepsis [4]. In this chapter, we discuss the role mito-chondrial dysfunction plays in critical illness and its manifestation as a disruption of cellular energetics. We suggest that the positive outcomes from the above-mentioned trials relate to a reduction of impaired mitochondrial function and a reduction in the subsequent generation of inflammatory signals.