Multiple organ dysfunction syndrome (mods)

Multiple organ dysfunction syndrome (mods)By: joahnna marie a. abuyan, rnMultiple organ dysfunction syndrome

previously known as multiple organ failure (MOF) or multisystem organ failure (MSOF), Is a condition that occurs when two or more organs or organ systems are unable to function in their role of maintaining homeostasis.MODS isnt an illness itself; rather, its a manifestation of another progressive underlying condition.The use of "multiple organ failure" or "multisystem organ failure" should be avoided since that phrase was based upon physiological parameters to determine whether or not a particular organ was failing.

Causes

SIRS (systemic inflammatory response syndrome)Sepsis- most common cause in operative and non-operative patientsInjury (accident, surgery)HypoperfusionHypermetabolism

Currently, investigators are looking into genetic targets for possible gene therapy to prevent the progression to Multiple organ dysfunction syndrome.

Some authors have conjectured that the inactivation of the transcription factorsNF-BandAP-1would be appropriate targets in preventingsepsisandSIRS.

Pathophysiology

Respiratory failureis common in the first 72 hours after the original insult. Hepatic failure(57 days)Gastrointestinal bleeding(1015 days)Renal failure(1117 days)

Gut hypothesisThe most popular hypothesis by Deitch to explain MODS in critically ill.

Endotoxin macrophage hypothesis

Gram-negativeinfections in MODS patients are relatively common,Endotoxinshave been advanced as principal mediator in this disorderIt is thought that following the initial eventcytokinesare produced and released. The pro-inflammatory mediators are:tumor necrosis factor-alpha(TNF-),interleukin-1, interleukin-6,thromboxaneA2,prostacyclin, platelet activating factor, andnitric oxide.

Tissue hypoxia-microvascular hypothesis

As a result of macro- and microvascular changes insufficient supply of oxygen occurs.Hypoxemiacauses cell death and organ dysfunction.

Integrated hypothesis

Since in most cases no primary cause is found, the condition could be part of a compromised homeostasis involving the previous mechanisms.

Diagnosis

The European Society of Intensive Care organized a consensus meeting in 1994 to create the "Sepsis-Related Organ Failure Assessment (SOFA)" score to describe and quantitate the degree of organ dysfunction in six organ systems. Using similar physiologic variables the Multiple Organ Dysfunction Score was developed.

Four clinical phases have been suggested:

Clinical Manifestations

Early findings may include:Fever- usually greater than 101F (38.3 C)TachycardiaNarrowed pulse pressureTachypneaDecreased pulmonary art ery pressure (PAP, PAWP, and CVP)Increased cardiac output

As SIRS progresses, findings reflect impaired perfusion of the tissues and organs such as:

Decreased LOCRespiratory depressionDiminished bowel soundsJaundiceOliguria or anuriaIncreased PAP and PAWPDecreased cardiac output

Diagnostic Tests

ABG analysisCBCXraysMRICT-SCANAngiography

Treatment

Mehanical Ventilation and supplemental oxygenHemodynamic MonitoringFluid infusion (crytalloids and colloids)VasopressorsSerial laboratory valuesDialysisAntimicrobial agents

Nursing Care and Management

Maintain the patients airway and breathing with the use of mechanical ventilation and supplemental oxygenMonitor vital signs, oxygen saturation, hemodynamic parameters and cardiac rhythm for arrhythmias.Administer IV fluids as ordered.Monitor laboratory values.Monitor intake and output.Administer appropriate medications as ordered.Provide emotional support to the patient and family.