Multiple Organ Dysfunction Syndrome: Difference between revisions

No edit summary
No edit summary
 
(4 intermediate revisions by 2 users not shown)
Line 6: Line 6:
== Introduction ==
== Introduction ==
[[File:Clinicians in Intensive Care Unit.jpg|right|frameless]]
[[File:Clinicians in Intensive Care Unit.jpg|right|frameless]]
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.  
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 name=":0">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>
Initial Injury: Almost any disease that results in tissue injury may result in MODS examples below:
 
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 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>
 
== Mechanism and Types of MODS ==
[[File:Cytokine release.jpg|right|frameless]]
In general, the cause of post injury MODS involves a mixed layering of patient, injury and treatment factors. The dysregulated immunological response is the crucial factor in the pathophysiology of post injury MODS.
 
Following the initial injury the following changes are proposed to occur
* Shock: Medical emergency in which the organs and tissues of the body are not receiving an adequate flow of blood. This deprives the organs and tissues of oxygen (carried in the blood) and allows the buildup of waste products. Shock can result in serious damage or even death<ref>The free dictionary [https://medical-dictionary.thefreedictionary.com/shock Shock] Available from: https://medical-dictionary.thefreedictionary.com/shock<nowiki/>(accessed 28.2.2021)</ref>
* Whole body Hyperfusion: A condition of acute peripheral circulatory failure due to derangement of circulatory control or loss of circulating fluid. It is marked by hypotension and coldness of the skin, and often by tachycardia and anxiety, can be fatal
* Resuscitation<ref name=":0" />: The restoration of consciousness to a person who appears dead.
* Reperfusion of ischaemic gut leads to [[Complement System|cascade]] of events: gut translocation of micro-organisms precipitating and/or perpetuating this [[Inflammation Acute and Chronic|inflammatory response]] -compensatory anti-inflammatory response (CARS) results in [[Immunocompromised Client|immunosupression]] and anergy
* Coagulation cascade - triggered by tissue factor, endotoxins, [[cytokines]] and bacterial [[Immunoglobulins (Ig)|antigen]]<nowiki/>s.
* Cyrokines (image 2 cytokine release): Pro-and anti-inflammatory cytokines are released excessively during the initial phase of trauma. The role of the anti-inflammatory cytokines is to down-regulate the production of pro-inflammatory cytokines. Normally, the balance of pro- and anti-inflammatory cytokines is in equilibrium, however, when this natural balance is unbalanced with the release of predominantly pro-inflammatory cytokines, this leads to Systemic inflammatory response syndrome, while predominance of anti-inflammatory cytokines causes immunosuppression.<ref name=":0" />
*Neuro-endocrine factors - neurally mediated immune-suppression - [[Stress and Health|stress]] responses involving adrenal hormones - hypothyroid state due to production of inert reverse T3 (Reverse T3 is sort of a hibernation hormone, in times of stress and chronic illness, it lowers your metabolism)<ref>THYROID LAB INTERPRETATION GUIDE Reverse 3 Available from: https://www.thyroidlabguide.com/reverse-t3.html (accessed 28.2.2021)</ref>
* [[Mitochondria]]<nowiki/>l dysfunction: may be mediated by humoral factors and may contribute to cellular dysoxia and organ dysfunction<ref name=":1" />
'''Other factors include''':
[[File:Chromosome-DNA-gene copy.jpg|right|frameless]]
[[Genetic Conditions and Inheritance|Genetics]]
* differences in gene expression and the proteome may account for individual differences in the likelihood and severity of MODS following a given stimulus
[[Multimorbidity|Comorbidities]]
* patients with premorbid organ dysfunction are more likely have further deterioration of organ function
Medications, therapies and [[ICU Delirium|ICU]] supports
* [[Ventilation and Weaning|ventilator]]-induced lung injury contributing to pulmonary cytokine release and [[Acute Respiratory Distress Syndrome (ARDS)|acute respiratory distress syndrome]] (ARDS)
* also: fluid therapy, hypothermia, ECMO, immobility, inotropes, blood products, etc<ref name=":1" />


== Symptoms ==
== Symptoms ==
The patient may display some of the following symptoms depending on which organs are affected:
The patient may display some of the following symptoms depending on which organs are affected:
* An altered mental state;
* Altered mental state;
* A decrease in renal perfusion (decrease in urine output);
* Decrease in renal perfusion (decrease in urine output);
* Respiratory deterioration;
* Respiratory deterioration;
* A decrease in cardiac function;
* Decrease in cardiac function
* Deranged metabolic status;
* Deranged metabolic status
* A compromised fluid balance;
* Compromised fluid balance
* Pale, clammy, peripherally cool skin and faint pedal pulses; and
* Pale, clammy, peripherally cool skin and faint pedal pulses
* A 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>.
* 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 ==
== Management and Treatment ==
[[File:Sepsis treatment.jpg|right|frameless]]
[[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).
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.  
Positive patient outcomes rely on immediate recognition, ICU admission, and invasive organ support.  


Management and treatment may include:
Management and treatment may include:
* Identifying and treating the underlying causes, comorbidities or complications;
* Identifying and treating the underlying causes, comorbidities, or complications;
* Fluid resuscitation to increase perfusion
* Fluid resuscitation to increase perfusion
* Support care and monitoring:
* Support care and monitoring including Multi-organ support; Mechanical or non-invasive ventilation; Maintaining fluid homeostasis; Renal replacement therapy.<ref name=":2" />
 
** Multi-organ support;
** Mechanical or non-invasive ventilation;
** Maintaining fluid homeostasis; and
** Renal replacement therapy.<ref name=":2" />


== References  ==
== References  ==
<references />
<references />
[[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)
Retrieved from "https://www.physio-pedia.com/index.php?title=Multiple_Organ_Dysfunction_Syndrome&oldid=354243"