Depicts timeline of evolving epidemiology of multiple organ failure (MOF). ICU, intensive care unit; PACs, pulmonary artery catheters; TPN, total parenteral nutrition;VO2, oxygen consumption; ATLS, advanced trauma life support; PMN, neutrophil; SIRS, systemic inflammatory response syndrome; CARS, compensatory anti-inflammatory response syndrome; DAMP; damage associated molecular patterns; PAMPs, pathogen associated molecular patterns; IEDs, immune enhancing diets SOPs, standard operating procedures; PICS, persistent, inflammation, immunosuppression, catabolism syndrome. (Reprinted with permission of Wolters Kluwer Health, Inc, from Gentile LF, Cuenca AG, Efron PA, Ang D, Bihorac A, McKinley BA, Moldawer LL, Moore FA. Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. J Trauma Acute Care Surg. 2012; volume 72, issue 6:1491–501).