MULTI ORGAN DYSFUNCTION SYNDROME - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE - Orthodnb.com

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE - Orthodnb.com

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Monday, 2 July 2018

MULTI ORGAN DYSFUNCTION SYNDROME

MULTI ORGAN DYSFUNCTION SYNDROME




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  • presence of physiological dysfunction and failure of two or more organs
  • MC cause of death in ICU – caused due to uncontrolled infection in abdomen or chest – also by non infectious causes like trauma, pancreatitis, burns, massive transfusions
  • Systemic Inflammatory Response Syndrome (2 or more of following)
    • temperature >380 or <360
    • heart rate >90
    • resp rate > 20 or PaCO2 <32mmHg
    • WBC >12000 or <4000/mm3
  • Organ dysfunction score
    • Grade I
      • S.Cr. >1.8 mg/100ml
      • Bb >2mg%
      • ARDS score >5
      • minimal inotropes needed
    • Grade II
      • S.Cr. >2.5
      • Bb >4
      • ARDS score >9
      • moderate inotropes
    • Grade III
      • S.Cr. >5
      • Bb > 8
      • ARDS score >13
      • high inotropes
  • other factors
    • pre existing disease
    • advanced age
    • intensity of inciting event and second hit
    • sepsis
    • number of organs involved – prognostic indicator of mortality
  • sequential organ failure – characteristic of MODS – pulmonary followed by hepatic – GIT – renal
  • pulmonary failure
    • ventilation perfusion abnormalities
    • non cardiac pulmonary edema
    • decreased FRC
    • refractory hypoxemia
    • decreased lung compliance
  • renal failure
    • due to tissue hypoperfusion or direct damage by inflammatory cells/ mediators
  • CVS and CNS manifestation may also present
Treatment
  • prevent shock or sepsis from progressing to MODS
    • aggressive resuscitation to establish optimal levels of oxygen delivery and consumption
    • oxygen delivery by volume expansion, blood transfusions, beta agonists, vasodilators, alpha agonists to improve cardiac contractillity, decrease afterload, increase arterial / perfusion pressure
  • monitor vital parameters
  • broad spectrum antibiotics – surgical drainage and debridement
  • prevent nosocomial infections or second hits – care of lines and catheters
  • nutritional support – positive protein balance – 25-35kcal/kg/day with 1.5 to 2gm/kg/day protein
  • enteral nutrition better than parenteral
    • cost effective
    • maintains integrity of gut
    • stimulates gall bladder function
    • reduces septic morbidity
    • less bacterial translocation from the gut
  • use of steroids questionable
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