Multiple Organ Dysfunction Syndrome
Multiple organ dysfunction syndrome (MODS) is altered organ function in an acutely ill patient requiring medical intervention to achieve homeostasis.
Causes of Multiple Organ Dysfunction Syndrome
The condition results from infection, injury (accident, surgery), hypoperfusion and hypermetabolism.
The primary cause triggers an uncontrolled inflammatory response.[citation needed]
Sepsis is the most common cause of multiple organ dysfunction syndrome and 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.
Symptoms of Multiple Organ Dysfunction Syndrome
The patient may display some of the following symptoms depending on which organs are affected:
An altered mental state
A decrease in renal perfusion (decrease in urine output)
Respiratory deterioration
A decrease in cardiac function
Deranged metabolic status
A compromised fluid balance
Pale, clammy, peripherally cool skin and faint pedal pulses
A decrease in cardiac output (e.g. low blood pressure, arrhythmia)
Diagnosis of Multiple Organ Dysfunction Syndrome
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.
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; develops moderate liver dysfunction and possible hematologic abnormalities.
Stage 3: the patient develops shock with azotemia and acid-base disturbances; has significant coagulation abnormalities.
Stage 4: the patient is vasopressor dependent and oliguric or anuric; subsequently develops ischemic colitis and lactic acidosis.
Prevention of Multiple Organ Dysfunction Syndrome
There is no particular medication that helps to prevent MODS. Researchers have investigated ways to treat early MODS to prevent worsening illness, but interventions can be controversial.
However, there is good evidence that healthcare providers can avoid worsening organ dysfunction by:
Minimizing trauma to the lungs during ventilatory support
Restricting blood transfusions until absolutely necessary
Avoiding medications that are toxic to the kidneys
Giving medications to prevent ulcers and bleeding in the stomach
Giving people good nutrition
Preventing hematologic complications by thinning the blood
Treatment of Multiple Organ Dysfunction Syndrome
At present, there is no drug or device that can reverse organ failure that has been judged by the health care team to be medically and/or surgically irreversible (organ function can recover, at least to a degree, in patients whose organs are very dysfunctional, where the patient has not died.
And some organs, like the liver or the skin, can regenerate better than others), with the possible exception of single or multiple organ transplants or the use of artificial organs or organ parts, in certain candidates in specific situations.
Therapy, therefore, is usually mostly 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