Multi-organ dysfunction syndrome

Question 1

Define MODS.

Answer 1

Progressive organ dysfunction in an acutely ill patient, such as homeostasis cannot be maintained without intervention.

It is on the spectrum of infectious (sepsis, septic shock) and non-infectious conditions (SIRS from pancreatitis etc).

Question 2

What is primary vs secondary MODS?

Answer 2

Primary - well-defined insult e.g. renal failure due to rhabdo
Secondary - not in direct response to an insult but a consequence of host response e.g. SIRS in pancreatitis

Question 3

What parameters are used to diagnose MODS in these organ systems:
* Respiratory
* Haematology
* Liver
* Renal
* Brain
* Cardiovascular

Answer 3

• Respiratory - PaO1/FiO2
• Haematology - platelet count
• Liver - bilirubin
• Renal - Cr or urine output
• Brain - GCS
• Cardiovascular - hypotension and need for vasopressors

Question 4

What is the significance of greater number of organ failures for prognosis?

Answer 4

Increased mortality
Greatest risk is associated with respiratory failure requiring mechanical ventilation

Question 5

List the causes of MODS.

Answer 5

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

Question 6

What is the management of MODS.

Answer 6

Identify and treat the cause, comorbidities and complications
Fluid resuscitation
Supportive care and monitoring
* multi-organ support
* mechanical or non-invasive ventilation
* maintaining fluid homeostasis
* renal replacement therapy

Question 7

What is the difference between SIRS and MODS?

Answer 7

SIRS is the result of sepsis
MODS can occur due to SIRS