Multi-Organ Failure (MOF)

Question 1

MODS

Answer 1

• multi-organ dysfunction syndrome

- (multi-organ failure)

Question 2

SIRS

Answer 2

• systemic inflammatory response syndrome

- can be caused by infection, inflammation, tissue injury, ischemia

Question 3

SIRS in the context of infection is known as what?

Answer 3

• sepsis!

Question 4

What is severe sepsis?

Answer 4

• sepsis with organ dysfunction

Question 5

What is septic shock?

Answer 5

• severe sepsis with hypotension

Question 6

Organ dysfunction in the lungs is known as:

Answer 6

• ARDS (acute respiratory distress syndrome)

- (acute lung injury)

Question 7

What is the pathophysiology behind ARDS?

Answer 7

• pulmonary edema that leads to impaired oxygenation

Question 8

How many stages of ARDS are there? What does each entail?

Answer 8

• 2 stages
• 1st stage: exudative phase; edema, impaired gas exchange
• 2nd stage: fibrotic phase; due to proliferation of fibroblasts and alveolar type II cells, pulmonary compliance is reduced, gas exchange worsens

Question 9

How do manage ARDS?

Answer 9

• treat the underlying cause
• give the patient O2
• mechanical ventilation
• prevent iatrogenic infection

Question 10

Organ dysfunction of the CVS presents as:

Answer 10

• septic shock

Question 11

What is the pathophysiology behind septic shock?

Answer 11

• decreased vascular resistance and increased capillary permeability (due to inflammation) results in massive fluid extravasation = hypovalemia

Question 12

How do we manage septic shock?

Answer 12

• • treat the underlying cause*

- fluid/volume resuscitation, O2, inotropes (to increase cardiac contractility), vasopressors (increase resistance)

Question 13

Organ dysfunction of the renal system is known as:

Answer 13

• AKI (acute kidney injury)

Question 14

What is the pathophysiology behind AKI?

Answer 14

• pre, intra, or post-renal

- hypoperfusion, ATN, urinary obstruction, respectively

Question 15

How do we manage AKI?

Answer 15

• treat the underlying cause

- fluid/volume resuscitation, avoid nephrotoxic drugs, maintain renal perfusion, dialysis if needed

Question 16

Organ dysfunction of the nervous system most commonly presents as:

Answer 16

• alterations in the level of consciousness

Question 17

Organ dysfunction of the GIT results in what? What is bacterial translocation?

Answer 17

• the gut stops working

- normal gut flora may enter the blood stream (this is bacterial translocation)

Question 18

In regards to hematology, what can occur in MODS/MOF?

Answer 18

• DIC (disseminated intravascular coagulation) can result from the inappropriate activation of coagulation

Question 19

What are the two types of therapies used in treating MODS/MOF? What is the purpose of each?

Answer 19

• 1) disease modifying therapies: treat the underlying cause (fix fractures, antibiotics, drain infections, etc.)
• 2) organ support therapies: keep the patient alive while the disease modifying therapies run their course (O2, IV fluids, ventilation, dilation, etc.)