MULTI ORGAN DYSFUNCTION SYNDROME
- 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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