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 an acute injury or illness

Question 2

What constitutes Multiorgan dysfunction syndrome?

Answer 2

Multiorgan: altered function in 2 or more organ systems during an acute illness such that homeostasis can’t be maintained without intervention

Question 3

Describe the aetiology of Multiorgan dysfunction syndrome

Answer 3

Usually results from:
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 11 causes of Multiorgan dysfunction syndrome

Answer 5

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

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

Presence of a systemic inflammatory response (SIRS criteria) + dysfunction of at least 2 organs.

Question 8

List presentations of Multiorgan dysfunction syndrome

Answer 8

AKI 
ARDS 
Cardiomyopathy 
Encephalopathy 
GI dysfunction: decreased motility + ileus, pancreatitis, stress ulceration, gut ischaemia 
Hepatic dysfunction 
Coagulopathy + bone marrow suppression

Question 9

What investigations are appropriate in Multiorgan dysfunction syndrome?

Answer 9

FBC with relevant added tests according to signs e.g. LFTs, amylase, etc
Monitor vital signs
ABG may be necessary to assess hypoxaemia, lactic acidosis etc.

Question 10

Describe the stages in the MODS scoring system

Answer 10

1: increased volume requirements, mild respiratory alkalosis, oliguria, hyperglycaemia, increased insulin requirements
2: tachypnoea, hypocapnia, hypoxaemia, moderate liver dysfunction + haematologic abnormalities
3: shock, azotaemia (high nitrogen in the blood), acid-base disturbance, significant coagulation abnormalities
4: vasopressor dependent, oliguria or anuria, development of ischaemic colitis + lactic acidosis