Multi-organ dysfunction syndrome

Question 1

Define:

Answer 1

A hypometabolic, immunodepressed state with clinical and biochemical evidence of decreased functioning of the body’s organ systems that develops subsequent to an acute injury or illness

Multi-organ - 2+ organs

Question 2

Causes:

Answer 2

o	Sepsis 
o	Major trauma
o	Burns
o	Pancreatitis
o	Aspiration syndromes
o	Extracorporeal circulation e.g. cardiac bypass
o	Multiple blood transfusion
o	Ischaemia-reperfusion injury
o	Autoimmune disease
o	Eclampsia
o	Poisoning

Question 3

What are the other independent factors:

Answer 3

o	Genetics
o	Comorbidities 
o	Medication, therapies and ICU supports i.e. ventilator-induced lung injury, fluid therapy, immobility
o	Macrocirculatory and microcirculatory changes
o	Inflammation 
o	Coagulation cascade
o	Neuro-endocrine factors
o	Mitochondrial dysfunction

Question 4

Epidemiology:

Answer 4

50% of ICU pts deaths

Question 5

Symptoms:

Answer 5

Varies depending on the organ affected

Question 6

Signs:

Answer 6

• Presence of a systemic inflammatory response (SIRS criteria) and dysfunction of at least 2 organs which can present as
o AKI
o ARDS
o Cardiomyopathy
o Encephalopathy
o GI dysfunction: decreased motility and ileus, pancreatitis, stress ulceration, gut ischaemia
o Hepatic dysfunction
o Coagulopathy and bone marrow suppression

Question 7

Investigations:

Answer 7

• FBC with relevant added tests according to signs e.g. LFTs, amylase
• Monitor closely