MODS --> Death So two mechanisms are impoant in septic shock :- i) Release of primary mediators of inflammation TNF? and IL-I. ii) Activation and damage to endothelium o Damage to endothelium leads to systemic inflammatory response which causes vasodilation and permeability leading to septic shock. o But the initial primary event is the release of primary mediators of inflammation cytokines as a result of interaction between bacterial cell wall components and host cell. The endothelium is subsequently activated and damaged by these mediators (cytokines). Therefore cvtokine release is the primary initiating factor in endotoxic shock. Infection (bacteria, fungi) Interaction of bacterial cell products with macrophages Release of primary mediation (cytokines) from macrophages Activation and damage to endothelium Release of secondary mediators o Vasodilation o Increased permeability o Decreased perfusion">