Multi Organ Dysfunction Syndrome (MODS)

Question 1

Define MODS

Answer 1

progressive physiological dysfunction of 2 or more organ systems where homeostasis cannot be maintained without intervention

Question 2

List the common causes of MODS

Answer 2

sepsis, septic shock, severe trauma, major surgery, burns, liver failure, ARF

Question 3

Compare primary and secondary insult MODS

Answer 3

primary: direct organ injury, shock, trauma, necrosis causing decreased perfusion, local inflammation, priming of immune cells leading to hyperreactive system
secondary insult: fall, injury, surgery triggering excessive systemic inflammation reaction from primed macrophages causing widespread endothelial damage, infection present amplifies this reaction, inflammation, metabolic stress, death

Question 4

What direct effect does immune priming have on cytokines and what does this cause?

Answer 4

immune priming increases pro-inflammatory cytokines and decreases anti-inflammatory cytokines which causes neutrophil and macrophage activation leading to dysregulated immune and inflammatory response

Question 5

Briefly describe the two hit model of MODS

Answer 5

first hit primes neutrophils and macrophages
second hit results in detrimental inflammatory response

Question 6

Describe the 2 descriptors/diagnoses of MODS

Answer 6

first: number of failing systems and need for clinical intervention for each, dysfunction of at least 2 organ AND systemic inflammatory response syndrome
second: vitals out of normal parameters

Question 7

Describe the incidence of MODS

Answer 7

most common cause of late trauma death, approx 50% of ICU patients develop it with 20-75% mortality rate, risk of death increases by 11-23% as each organ fails

Question 8

Discuss treatment of MODS

Answer 8

no cure, management aims to maintain adequate tissue oxygenation, less a syndrome to be treated more a complication to be avoided