Multiorgan dysfunction syndrome

Question 1

What is Multiorgan dysfunction syndrome?

Answer 1

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

Question 2

What constitutes Multiorgan dysfunction syndrome?

Answer 2

Altered function in >,2 organ systems during an acute illness
Homeostasis can’t be maintained without intervention

Question 3

Describe the aetiology of Multiorgan dysfunction syndrome

Answer 3

Infection
Injury
Hypoperfusion
Hypermetabolism
This primary cause can trigger a systemic inflammatory response (sepsis or SIRS)
MODS is the final stage in a continuum beginning with SIRS + infection:
SIRS + infection -> sepsis -> severe sepsis -> MODS

Question 4

Describe the epidemiology of Multiorgan dysfunction syndrome

Answer 4

Uncommon

Contributes to~50% of ICU deaths

Question 5

List 6 causes of Multiorgan dysfunction syndrome

Answer 5

Any disease that results in tissue injury e.g.
Sepsis  
Major trauma 
Burns 
Pancreatitis 
Aspiration syndromes 
AI disease

Question 6

List 8 interdependent factors that contribute towards Multiorgan dysfunction syndrome

Answer 6

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

Question 7

Describe presenting symptoms of Multiorgan dysfunction syndrome

Answer 7

Varies depending on organs affected

Question 8

List presentations of Multiorgan dysfunction syndrome

Answer 8

Decreased urine (AKI + uraemic acidosis)
SOB, Tachypnoea (ARDS)
Hypotension (Cardiomyopathy)
AMS (Encephalopathy)
GI dysfunction: decreased motility + ileus, pancreatitis, stress ulceration, gut ischaemia
Hyperbilirubinemia + cholestasis (Hepatic)
Coagulopathy + BM suppression

Question 9

What investigations are appropriate in Multiorgan dysfunction syndrome?

Answer 9

Bloods with relevant added tests according to signs e.g. LFTs, amylase, etc
Monitor vital signs
ABG: to assess hypoxaemia, lactic acidosis etc.

Question 10

Tx for multi organ dysfunction syndrome

Answer 10

Abx
Fluids + O2 for reperfusion
Organ-targeted drugs
Correction of coagulation abnormalities, acid-base imbalance; metabolic + electrolyte imbalances