Multiple organ dysfunction syndrome

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Overview

Multiple organ dysfunction syndrome MODS, previously known as multiple organ failure (MOF), is altered organ function in an acutely ill patient requiring medical intervention to perform homeostasis. The use of "multiple organ failure" should be avoided since that term was based upon physiologic parameters to determine whether or not a particular organ was failing.^[1]

Origin

Originally patients were classified as having sepsis or the sepsis syndrome. This resulted in two concepts: the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS).^[1]

Definition

Multiple organ dysfunction syndrome is the presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention. It usually involves two or more organ systems.^[1]

Aetiology

The condition usually results from infection, injury (accident, surgery), hypoperfusion and hypermetabolism. The primary cause triggers an uncontrolled inflammatory response. In operative and non-operative patients sepsis is the most common cause. Sepsis may result in septic shock. In the absence of infection a sepsis-like disorder is termed systemic inflammatory response syndrome (SIRS). Both SIRS and sepsis could ultimately progress to multiple organ dysfunction syndrome. However, in one-third of the patients no primary focus can be found.^[1]

Pathophysiology

A definite explanation has not been found. Local and systemic responses are initiated by tissue damage. Respiratory failure is common in the first 72 hours after the original insult. Following this one might see hepatic failure (5-7 days), gastrointestinal bleeding (10-15 days), and renal failure (11-17 days)^[1]

Gut hypothesis

The most popular theory to explain MODS in critically ill patients is the gut hypothesis. Due to splanchnic hypoperfusion and the subsequent mucosal ischaemia there are structural changes and alterations in cellular function. This results in increased gut permeability, changed immune function of the gut and increased translocation of bacteria. Hepatic dysfunction leads to toxins escaping into the systemic circulation and activating an immune response. This results in tissue injury and organ dysfunction.^[1]

Endotoxin macrophage theory

Gram-negative infections in MODS patients are relatively common, hence endotoxins have been advanced as principal mediator in this disorder. It is thought that following the initial event cytokines are produced and released. The pro-inflammatory mediators are: tumor necrosis factor-alpha (TNF-α), interleukin-1, interleukin-6, thromboxane A2, prostacyclin, platelet activating factor, and nitric oxide.^[1]

Tissue hypoxia-microvascular hypothesis

As a result of macro- and microvascular changes insufficient supply of oxygen occurs. Hypoxemia causes organ dysfuntion and cell death.^[1]

Integrated hypothesis

Since in most cases no primary cause is found, the condition could be part of a compromised homeostasis involving the previous mechanisms.^[1]

Diagnosis

The European Society of Intensive Care organized a consensus meeting in 1994 to create the "Sepsis-Related Organ Failure Assessment (SOFA)" score to describe and quantitate the degree of organ dysfunction in six organ systems. Using similar physiologic variables the Multiple Organ Dysfunction Score was developed.^[1]

Four clinical phases have been suggested:

• Stage 1 the patient has increased volume requirements and mild respiratory alkalosis which is accompanied by oliguria, hyperglycemia and increased insulin requirements.
• Stage 2 the patient is tachypneic, hypocapnic and hypoxemic. Moderate liver dysfunction and possible hematologic abnormalities.
• Stage 3 the patient develops shock with azotemia and acid-base disturbances. Significant coagulation abnormalities.
• Stage 4 the patient is vasopressor dependent and oliguric or anuric. Ischemic colitis and lactic acidosis follow.

Management

At present there is no agent that can reverse the established organ failure. Therapy therefore is limited to supportive care, i.e. safeguarding hemodynamics, and respiration. Maintaining adequate tissue oxygenation is a principal target. Starting enteral nutrition within 36 hours of admission to an Intensive care unit has reduced infectious complications. ^[1]

Prognosis

Mortality varies from 30% to 100% where the chance of survival is diminished as the number of organs involved increases. Since the 1980s the mortality rate has not changed.

See also

• Acute renal failure
• Acute respiratory distress syndrome
• Heart failure
• Intensive care
• Liver failure
• Respiratory insufficiency
• Shock
• systemic inflammatory response syndrome

References

1. ↑ ^{1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10} Intensive Care Medicine by Irwin and Rippe

Sources

• Intensive Care Medicine by Irwin and Rippe
• The ICU Book by Marino
• Cecil Textbook of Medicine
• The Oxford Textbook of Medicine
• Harrison's Principles of Internal Medicine

v • d • e Health Science · Medicine · Medical specialities · Intensive care medicine / Critical care medicine and Critical care nursing
General terms	Intensive care unit (ICU) · Neonatal intensive care unit (NICU) · Pediatric intensive care unit (PICU) · Coronary care unit (CCU) · Critical illness insurance
Conditions	Organ system failure Acute renal failure · Acute respiratory distress syndrome · Acute liver failure · Cardiogenic shock · Coma · Distributive shock · Multiple organ dysfunction syndrome · Polytrauma · Respiratory failure · Sepsis · Septic shock · Shock · Systemic inflammatory response syndrome Complications Critical illness polyneuropathy / myopathy · Critical illness–related corticosteroid insufficiency · Decubitus ulcers · Fungemia · Stress hyperglycemia · Stress ulcer Iatrogenesis Methicillin-resistant Staphylococcus aureus · Oxygen toxicity · Refeeding syndrome · Ventilator-associated lung injury · Ventilator-associated pneumonia
Diagnosis	Arterial blood gas · Arterial catheter · Blood cultures · Central venous catheter · Pulmonary artery catheter · Screening cultures
Life supporting treatments	Airway management · Chest tube · Dialysis · Enteral feeding · Goal-directed therapy · Induced coma · Mechanical ventilation · Therapeutic hypothermia · Total parenteral nutrition
Drugs	Analgesics · Antibiotics · Antithrombotics · Inotropes · Intravenous fluids · Neuromuscular-blocking drugs · Recombinant activated protein C · Sedatives · Stress ulcer prevention drugs · Vasopressors
ICU scoring systems	APACHE II · Glasgow Coma Scale · PIM2 · SAPS II · SAPS III · SOFA
Organisations	Society of Critical Care Medicine · Surviving Sepsis Campaign
Related specialties	Anesthesia · Cardiology · Internal medicine · Neurology · Pediatrics · Pulmonology · Surgery · Traumatology

v • d • e WikiDoc Research Resources for Multiple organ dysfunction syndrome
Articles on Multiple organ dysfunction syndrome	Most recent articles on Multiple organ dysfunction syndrome • Most cited articles on Multiple organ dysfunction syndrome • Review articles on Multiple organ dysfunction syndrome • Articles on Multiple organ dysfunction syndrome in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Multiple organ dysfunction syndrome	Powerpoint slides on Multiple organ dysfunction syndrome • Images of Multiple organ dysfunction syndrome • Photos of Multiple organ dysfunction syndrome • Podcasts & MP3s on Multiple organ dysfunction syndrome • Videos on Multiple organ dysfunction syndrome
Evidence Based Medicine Regarding Multiple organ dysfunction syndrome	Cochrane Collaboration on Multiple organ dysfunction syndrome • Bandolier on Multiple organ dysfunction syndrome • TRIP on Multiple organ dysfunction syndrome
Cost Effectiveness of Multiple organ dysfunction syndrome	Cost Effectiveness of Multiple organ dysfunction syndrome
Clinical Trials Involving Multiple organ dysfunction syndrome	Ongoing Trials on Multiple organ dysfunction syndrome at Clinical Trials.gov • Trial results on Multiple organ dysfunction syndrome • Clinical Trials on Multiple organ dysfunction syndrome at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Multiple organ dysfunction syndrome	US National Guidelines Clearinghouse on Multiple organ dysfunction syndrome • NICE Guidance on Multiple organ dysfunction syndrome • NHS PRODIGY Guidance • FDA on Multiple organ dysfunction syndrome • CDC on Multiple organ dysfunction syndrome
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Genetics, Pharmacogenomics, and Proteinomics of Multiple organ dysfunction syndrome	Genetics of Multiple organ dysfunction syndrome • Pharmacogenomics of Multiple organ dysfunction syndrome • Proteomics of Multiple organ dysfunction syndrome
Newstories on Multiple organ dysfunction syndrome	Multiple organ dysfunction syndrome in the news • Be alerted to news on Multiple organ dysfunction syndrome • News trends on Multiple organ dysfunction syndrome
Commentary on Multiple organ dysfunction syndrome	Blogs on Multiple organ dysfunction syndrome
Patient Resources on Multiple organ dysfunction syndrome	Patient resources on Multiple organ dysfunction syndrome • Discussion groups on Multiple organ dysfunction syndrome • Patient Handouts on Multiple organ dysfunction syndrome • Directions to Hospitals Treating Multiple organ dysfunction syndrome • Risk calculators and risk factors for Multiple organ dysfunction syndrome
Healthcare Provider Resources on Multiple organ dysfunction syndrome	Symptoms of Multiple organ dysfunction syndrome • Causes & Risk Factors for Multiple organ dysfunction syndrome • Diagnostic studies for Multiple organ dysfunction syndrome • Treatment of Multiple organ dysfunction syndrome
Continuing Medical Education (CME) Programs on Multiple organ dysfunction syndrome	CME Programs on Multiple organ dysfunction syndrome
International Resources on Multiple organ dysfunction syndrome	Multiple organ dysfunction syndrome en Espanol • Multiple organ dysfunction syndrome en Francais
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de:Multiorganversagen