Systemic Inflammatory Response Syndrome (SIRS) and MODS Flashcards
overwhelming inflammatory response in the absence
of infection causing relative hypovolemia and
decreased tissue perfusion
SYSTEMIC INFLAMMATORY RESPONSE
SYNDROME
There is local cytokine production with the
goal of inciting an inflammatory response thereby
promoting wound repair and recruitment of the
reticular endothelial system
PATHOPHYSIOLOGY (SIRS)
3 Stage Process by Dr. RC Bone
1. Stage I:
Small quantities of local cytokines are
released into circulation to improve the local
response. This leads to growth factor stimulation and
the recruitment of macrophages and platelets.
PATHOPHYSIOLOGY (SIRS)
3 Stage Process by Dr. RC Bone
Stage II:
PATHOPHYSIOLOGY (SIRS)
3 Stage Process by Dr. RC Bone
Stage III
If homeostasis is not restored, a significant
systemic reaction occurs. The cytokine release leads
to destruction rather than protection.
FOUR SIRS CRITERIA
Tachycardia
Tachypnea
Hypothermia
Leukocytosis
a bedside prompt that
may identify patients with suspected infection who are
at greater risk for a poor outcome outside the
intensive care unit (ICU).
Q SOFA
Leukocytosis, leukopenia, or bandemia - white
blood cells number
> 1,200/mm3, <4,000/mm3 or bandemia
≥10%
3 component assessment system with: Q SOFA
- Systolic blood pressure ≤100 mmHg
- Highest respiratory rate ≥22 breaths per min
- Lowest Glasgow coma score <15
- Systolic blood pressure ≤100 mmHg
- Highest respiratory rate ≥22 breaths per min
- Lowest Glasgow coma score <15
Sepsis
s an illness severity score commonly used
in critical care medicine to predict mortality
upon admission to an intensive care unit.
Acute Physiology and Chronic Health Evaluation
(APACHE) score
scoring system was released
in 1985 and included a reduction in the
number of variables to 12.
The APACHE II
is well
validated and updated regularly, but its use is
limited by the fact that clinicians must pay to
know and use its equation for calculating
death probability
The Acute Physiology and Chronic Health
Evaluation (APACHE) score version II and III
➢ APACHE III
is a mortality
prediction score that is based on the degree
of dysfunction of 6 organ systems.
Sequential Organ Failure Assessment (SOFA)
➢ The Sequential Organ Failure
Assessment (SOFA)
assesses six systems in terms of
the extent of dysfunction on the first day of
an intensive care unit (ICU) stay.
The logistic organ dysfunction system
(LODS)
6 Systems : Logistic Organ Dysfunction (LOD) Score
Neurologic, Cardiovascular,
Renal, Pulmonary, Hematologic, and Hepatic
systems
is altered organ function in an acutely ill patient that
requires medical intervention to support continued
organ function.
MULTI ORGAN DYSFUNCTION SYNDROME (MODS)
which occurs most often when the initiating
event is a pulmonary one such as lung injury,
the patient experiences respiratory
compromise that necessitates intubation.
This usually occurs within 72 hours of the
initiating event
Primary MODS
Primary MODS
ASSESSMENT FINDINGS
Fever, usually greater than 101° F (38.3° C) (early
indicator)
● Tachycardia
● Narrowed pulse pressure
● Tachypnea
It occurs most often in the patient with septic
shock and progressively unfolds over about
1 month.
➢ The patient also experiences respiratory
failure and requires intubation.
SECONDARY MODS
SECONDARY MODS
MEDICAL MANAGEMENT
Early detection and documentation of initial signs of
infection are essential in managing elderly patients
with MODS
ASSESSMENT
EARLY MODS
Vasodilation and decreased PVR with normal BP
● CO increases to maintain BP
● Hypovolemia due to capillary permeability & interstitial
fluid loss
● Skin: warm, pink & dry
ASSESSMENT
LATE MODS
Hypotension
● Weak thready pulse
● ECG: ST & T waves changes (myocardial perfusion)
● Skin: cold, moist, pale, mottling cyanosis
PLANNING AND IMPLEMENTATION
❑ Drug therapy MODS
Antibiotics: broad-spectrum until specific organism
identified
● Antacids, histamine antagonists, sucralfate
● Analgesic / anti-anxiety agents
