Multiorgan Dysfunction Syndrome

Severe derangement of multiple organ systems occurring secondary to an acute disease process.

This is related to, but distinct from, SIRS; as SIRS does not necessarily imply organ dysfunction.

Epidemiology and Risk Factors

The syndrome has also been described as: multiorgan failure, multiple system failure, and shock lung.

Pathophysiology

Poorly understood, but includes multiple factors (predominantly functional) including:

  • Inflammatory dysfunction
    • Compensatory Anti-Inflammatory Response Syndrome
      State of immunosuppression secondary to exaggerated expression of anti-inflammatory mediators.
  • Coagulopathy
  • Circulatory dysfunction
    • Macrocirculatory dysfunction
      Often shock states with normal or high DO2.
    • Microcirculatory dysfunction
  • Mitochondrial dysfunction
  • Neurohumoral and endocrine dysfunction

Aetiology

Any disease that causes tissue damage can lead to MODS, however particular risk factors include:

  • CVS
    • Cardiac arrest
    • Extracorporeal circulation
      • Bypass
        • Circulatory arrest
      • ECMO
  • Metabolic
    • Hyperthermia
  • GIT
    • Pancreatitis
  • Infection
  • Obstetric
    • Eclampsia
  • Toxins
  • Major trauma
    • Massive transfusion
    • Burns

Management

Treatment is fundamentally good, early, supportive care. Principles include:

  • Early recognition of illness
  • Early resuscitation
  • Early definitive treatment
  • Prevention of secondary injury

References

  1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.