PLA2 is a family of regulatory enzymes that control eicosanoid synthesis and PAF production. PLA2 must be tightly regulated within the cell or cell destruction results. Circulatory release of PLA2 occurs in states of profound illness including sepsis, shock, severe injury, and pancreatitis, all of which are linked to the development of ARDS and MOF. Experimental and clinical evidence suggests that PLA2 may serve a primary regulatory role in the development of these inflammatory disorders. This evidence suggests that inhibitors of PLA2 activation could play an important role in future intensive care management.