To the Editor. —In their review of the literature on multiple organ failure (MOF), Drs Beal and Cerra1focus almost exclusively on the biochemical aspects of MOF. We write to call attention to additional and important physical changes such as separation of capillary endothelial cell junctions. Such physical changes interact with biochemical changes to complicate patient recovery. All these changes lead to capillary leak.2The leak releases water, electrolytes, and albumin into the extracellular or third space. Enlargement of the third space physically multiplies the distance between the delivery system's capillary membrane and the mitochondria of the cell. Diffusion of oxygen and other substances slows across the lungs and in tissues. The resultant decline in oxygen delivery and oxygen consumption and the increase in oxygen debt are three changes that uniformly accompany MOF and shock. Furthermore, the enlarged third space physically compresses tissues and often hampers diuresis. Diuresis
