MODS

Question 1

What are endothelial cells most important function? How are they activated?

Answer 1

Regulation of permeability. They are activated by alterations in local environment; the “cross talk” between RBC’s, plts, WBC’s and vascular muscle cells. They are responsible for the release of mediators.

Question 2

Mediators are released from the endothelial cells. What are they responsible for?

Answer 2

• elicit inflammatory response
• recruit WBC
• promote local clotting
• contain infxn

Question 3

What goes wrong at the cellular level to induce MODS?

Answer 3

Containment of the localized inflammatory response limits further damage to the host, however when the host response generalized, it escapes the “checks & balances”, leasing to an unregulated inflammatory response or SIRS.

Question 4

When is SIRS manifested?

Answer 4

• In the presence of infection (sepsis), but it can be manifested in the absence of infection as well.
• MODS, ALI, & ARF are complications of SIRS
• Diagnosed when at least 2/4 clinical manifestations occur in high risk patients.

Question 5

What populations are at risk for SIRS?

Answer 5

• > 65 y/o
• Trauma patients
• ETOH/drug abusers
• Genetics predisposing to infxn
• Burn patients

Question 6

What are the clinical manifestations of SIRS?

Answer 6

• Temp > 100.4 (38) or < 36
• HR >90/min
• R > 20/min or PaCO2 < 32
• WBC > 12 or < 4, or > 10% bands

Question 7

What is patient outcome directly related to?

Answer 7

Number of organs involved.

Question 8

What’s the difference between primary and secondary MODS?

Answer 8

Primary: Well defined insult
Secondary: Widespread, not well defined insult; generalized.

Question 9

What are the pathological changes with MODS?

Answer 9

• Uncontrolled systemic inflammation
• Tissue hypoxia
• Unregulated cell death
• Microvascular coagulopathy

Question 10

• What do the inflammatory cells do?

Answer 10

Produce and release mediators.