Multiple Organ Dysfunction Syndrome
Multiple organ dysfunction syndrome (MODS) alters organ function in
acutely ill patients that requires medical intervention to support continued organ function. MODS is actually another phase in the progression of shock states.
Multiple organ dysfunction syndrome is difficult to verify mainly because of the lack of consistent definitions to describe organ failure that is found in many cases of MODS. It is estimated that mortality rates of this condition can reach as high as 75% as indicated in annual reports from hospitals of major developing countries such as the United States, Canada and Britain. Furthermore, the actual incidence of MODS is very hard to determine since it develops along with acute illnesses that severely compromise tissue function.
Pathophysiology of multiple organ dysfunction syndrome
Multiple organ dysfunction syndrome can be classified as primary or secondary. Primary MODS is the result of direct tissue injury and compromise which then results in impaired perfusion of ischemia. Secondary MODS is most often a complication of any form of systemic inflammation response syndrome and sepsis. However, MODS may also be a complication of any form of shock because of inadequate tissue perfusion. As previously described in shock all organ systems suffer damage from a lack of adequate perfusion that can inevitably end in organ failure. Sequential organ failure has been further observed in many cases of MODS and the exact cause is yet to be determined by medical studies.
Various causes of MODS have been identified, including dead or injured tissue, infection, and perfusion deficits. However, it is not possible as yet to predict which individuals will end up developing MODS, partly because much of the organ damage occurs at the cellular level therefore cannot be directly observed or measured.
Clinical manifestations of multiple organ dysfunction syndrome
In both primary and secondary multiple organ dysfunction syndrome, an initial event result in low blood pressure. After treatment for the cause of the decrease in blood pressure, the individual appears to respond. In primary MODS, which occurs most often when the initiating event is pulmonary in origin (lung injury), the individual experiences respiratory compromise that necessitates intubation and supporting ventilation. In secondary MODS, which occurs most often in patients with septic shock, the pattern is much more insidious and progressively unfolds over a span of one month. The onset of organ dysfunction is an ominous sign that the more organs that fail, the worse is the outcome and the poorer is the prognosis.
Medical management of multiple organ dysfunction syndrome
Prevention remains to be the top priority in managing multiple organ dysfunction syndrome. Elderly patients are at an increased risk for MODS
mainly because of the lack of physiologic reserve associated with the normal effects of the ageing process and natural degenerative process. Early detection and documentation of initial signs of infection are very essential in managing MODS in elderly patients. Other individuals at high risk for MODS include those suffering from chronic illnesses, malnutrition, immunosuppression, surgical and traumatic wounds. If preventive measures fail, treatment measures to reverse multiple organ dysfunction syndrome are aimed at (1) controlling the initiating event, (2) promoting adequate organ perfusion and (3) providing nutritional support.