Multiple Organ Dysfunction Syndrome: Difference between revisions

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== Introduction ==
== Introduction ==
Multiple organ dysfunction syndrome (MODS) is a systemic, dysfunctional inflammatory response that requires long intensive care unit (ICU) stay. It is characterized with high mortality rate depending on the number of organs involved.  
[[File:Clinicians in Intensive Care Unit.jpg|right|frameless]]
Multiple organ dysfunction syndrome (MODS) is a syndrome, associated with the failure of one or more organ systems. Failure of these multiple organ systems is not necessarily related to the initial injury or disease process.<ref name=":0">Mayo Clinic [https://mayoclinic.pure.elsevier.com/en/publications/multiple-organ-dysfunction-syndrome Multiple organ dysfunction syndrome] Available:https://mayoclinic.pure.elsevier.com/en/publications/multiple-organ-dysfunction-syndrome (accessed 1.1.2023)</ref> MODS results from of a dysregulated inflammatory response, triggered by diverse factors.


It has been recognized that organ failure does not occur as an all-or-none rule, but rather a range of organ dysfunction exists resulting in clinical organ failure.<ref>El-Menyar A, Al Thani H, Zarour A, Tuma M, AbdulRahman H, Parchani A, Peralta R, Latifi R. [https://file.scirp.org/pdf/IJCM_2013010210123433.pdf Multiple Organ Dysfunction Syndrome (MODS): is it preventable or inevitable?].Available from:https://file.scirp.org/pdf/IJCM_2013010210123433.pdf (accessed 28.2.2021)</ref>
* No fully effective therapy has been developed that modulates this [[Inflammation Acute and Chronic|inflammatory]] response, incidence, or severity of MODS. 
* In current ICU practice, treatment is focused on prevention and treating individual organ dysfunction as it develops. 
* MODS is the leading cause of morbidity and mortality in current ICU practice.<ref name=":0" />  


Multiple organ dysfunction syndrome is the clinical consequence of a dysregulated inflammatory response, triggered by clinically diverse factors with the main pillar of management being invasive organ support.  
Given the lack of effective treatment for MODS, its early recognition, early ICU admission, and the initiation of invasive organ support remain the most effective strategies for preventing its progression and improving outcomes<ref>Gourd NM, Nikitas N. [https://journals.sagepub.com/doi/10.1177/0885066619871452 Multiple organ dysfunction syndrome.] Journal of intensive care medicine. 2020 Dec;35(12):1564-75.Available from: https://journals.sagepub.com/doi/10.1177/0885066619871452 (accessed 28.2.2021)</ref>.


During the last years, the advances in the clarification of the molecular pathways that trigger, mitigate, and determine the outcome of MODS have led to the increasing recognition of MODS as a distinct disease entity with distinct etiology, pathophysiology, and potential future therapeutic interventions.  
== Aetiology ==
The pathophysiology of MODS is not completely known.<ref name=":0" /> The dysregulated immunological response is a crucial factor in the pathophysiology of post-injury MODS.  


Given the lack of effective treatment for MODS, its early recognition, the early intensive care unit admission, and the initiation of invasive organ support remain the most effective strategies of preventing its progression and improving outcomes<ref>Gourd NM, Nikitas N. [https://journals.sagepub.com/doi/10.1177/0885066619871452 Multiple organ dysfunction syndrome.] Journal of intensive care medicine. 2020 Dec;35(12):1564-75.Available from: https://journals.sagepub.com/doi/10.1177/0885066619871452 (accessed 28.2.2021)</ref>.
Almost any disease that results in tissue injury may result in MODS examples being: [[Sepsis]]; Major trauma; [[Burns Overview|Burns]]; [[Pancreatitis]]; Extracorporeal circulation (e.g. cardiac bypass); Multiple blood transfusion; [[Autoimmune Disorders|Autoimmune disease]]; [[Heat Illness in Sports|Heat-induced illness;]] Eclampsia; Poisoning/toxicity<ref name=":1">In the fast lane [https://litfl.com/multiple-organ-dysfunction-syndrome/ MODS] Available from:https://litfl.com/multiple-organ-dysfunction-syndrome/ (accessed 28.2.2021)</ref>


== Causes ==
{{#ev:youtube|0o_jFKbEbTg|300}}<ref>Nursing School Explained. Multiple Organ Dysfunction Syndrome (MODS). Available from: https://www.youtube.com/watch?v=0o_jFKbEbTg [last accessed 12/05/2024]</ref>
Almost any disease that results in tissue injury may result in MODS


Sepsis; Major trauma; Burns; Pancreatitis; Aspiration syndromes; Extracorporeal circulation (e.g. cardiac bypass); Multiple blood transfusion; Ischaemia–reperfusion injury; Autoimmune disease; Heat-induced illness; Eclampsia; Poisoning/toxicity<ref>In the fast lane [https://litfl.com/multiple-organ-dysfunction-syndrome/ MODS] Available from:https://litfl.com/multiple-organ-dysfunction-syndrome/ (accessed 28.2.2021)</ref>
== Symptoms ==
The patient may display some of the following symptoms depending on which organs are affected:
* Altered mental state;
* Decrease in renal perfusion (decrease in urine output);
* Respiratory deterioration;
* Decrease in cardiac function
* Deranged metabolic status
* Compromised fluid balance
* Pale, clammy, peripherally cool skin and faint pedal pulses
* Decrease in cardiac output (e.g. low blood pressure, arrhythmia)<ref name=":2">Ausmed MODS Available from:https://www.ausmed.com/cpd/articles/multiple-organ-dysfunction-syndrome (accessed 28.2.2021)</ref>.
== Management and Treatment ==
[[File:Sepsis treatment.jpg|right|frameless]]
MODS is difficult to treat, escalates quickly, and is often fatal. Therefore, early detection is crucial in preventing its progression (Wang et al. 2017).


Injury>> shock >> whole body hypoperfusion >> resuscitation >> reperfusion of ischaemic gut >> release of cytokines (IL6, IL8
Positive patient outcomes rely on immediate recognition, ICU admission, and invasive organ support.


and IL10) >> proinflammatory lipids and proteins from the reperfused splanchnic bed >> these mediators return to vascular
Management and treatment may include:
 
* Identifying and treating the underlying causes, comorbidities, or complications;
circulation via lymphatics >> prime PMNs >> PMNs mobilise into vascular circulation >> a significant neutrophillia at 3 h
* Fluid resuscitation to increase perfusion
 
* Support care and monitoring including Multi-organ support; Mechanical or non-invasive ventilation; Maintaining fluid homeostasis; Renal replacement therapy.<ref name=":2" />
postinjury >> ‘‘vulnerable window’’ >> A second hit during this period??: cipitate MOF, eutrophillia normally
 
resolves without endorgan damage.
 
Yes >> pre No >>
 
Figure 1. Causes, mechanism and types of multiorgan dysfunction syndrome.
 
== Sub Heading 3 ==
 
== Resources  ==
*bulleted list
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#numbered list
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== References  ==
== References  ==
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[[Category:Cardiopulmonary ]]
[[Category:Acute Care]]
[[Category:Interventions ]]
[[Category:Critical Care]]

Latest revision as of 09:50, 12 May 2024

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Uchechukwu Chukwuemeka and Carina Therese Magtibay  

Introduction[edit | edit source]

Clinicians in Intensive Care Unit.jpg

Multiple organ dysfunction syndrome (MODS) is a syndrome, associated with the failure of one or more organ systems. Failure of these multiple organ systems is not necessarily related to the initial injury or disease process.[1] MODS results from of a dysregulated inflammatory response, triggered by diverse factors.

  • No fully effective therapy has been developed that modulates this inflammatory response, incidence, or severity of MODS.
  • In current ICU practice, treatment is focused on prevention and treating individual organ dysfunction as it develops.
  • MODS is the leading cause of morbidity and mortality in current ICU practice.[1]

Given the lack of effective treatment for MODS, its early recognition, early ICU admission, and the initiation of invasive organ support remain the most effective strategies for preventing its progression and improving outcomes[2].

Aetiology[edit | edit source]

The pathophysiology of MODS is not completely known.[1] The dysregulated immunological response is a crucial factor in the pathophysiology of post-injury MODS.

Almost any disease that results in tissue injury may result in MODS examples being: Sepsis; Major trauma; Burns; Pancreatitis; Extracorporeal circulation (e.g. cardiac bypass); Multiple blood transfusion; Autoimmune disease; Heat-induced illness; Eclampsia; Poisoning/toxicity[3]

[4]

Symptoms[edit | edit source]

The patient may display some of the following symptoms depending on which organs are affected:

  • Altered mental state;
  • Decrease in renal perfusion (decrease in urine output);
  • Respiratory deterioration;
  • Decrease in cardiac function
  • Deranged metabolic status
  • Compromised fluid balance
  • Pale, clammy, peripherally cool skin and faint pedal pulses
  • Decrease in cardiac output (e.g. low blood pressure, arrhythmia)[5].

Management and Treatment[edit | edit source]

Sepsis treatment.jpg

MODS is difficult to treat, escalates quickly, and is often fatal. Therefore, early detection is crucial in preventing its progression (Wang et al. 2017).

Positive patient outcomes rely on immediate recognition, ICU admission, and invasive organ support.

Management and treatment may include:

  • Identifying and treating the underlying causes, comorbidities, or complications;
  • Fluid resuscitation to increase perfusion
  • Support care and monitoring including Multi-organ support; Mechanical or non-invasive ventilation; Maintaining fluid homeostasis; Renal replacement therapy.[5]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Mayo Clinic Multiple organ dysfunction syndrome Available:https://mayoclinic.pure.elsevier.com/en/publications/multiple-organ-dysfunction-syndrome (accessed 1.1.2023)
  2. ↑ Gourd NM, Nikitas N. Multiple organ dysfunction syndrome. Journal of intensive care medicine. 2020 Dec;35(12):1564-75.Available from: https://journals.sagepub.com/doi/10.1177/0885066619871452 (accessed 28.2.2021)
  3. ↑ In the fast lane MODS Available from:https://litfl.com/multiple-organ-dysfunction-syndrome/ (accessed 28.2.2021)
  4. ↑ Nursing School Explained. Multiple Organ Dysfunction Syndrome (MODS). Available from: https://www.youtube.com/watch?v=0o_jFKbEbTg [last accessed 12/05/2024]
  5. ↑ 5.0 5.1 Ausmed MODS Available from:https://www.ausmed.com/cpd/articles/multiple-organ-dysfunction-syndrome (accessed 28.2.2021)
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