Multiple organ dysfunction syndrome

Sepsis is a continuum of physiologic stages characterized by infection, systemic inflammation, and hypoperfusion with widespread tissue injury.1 The American College of Chest Physicians and the Society of Critical Care Medicine developed definitions to utilize for sepsis (Table 79—l).2 They provide physiologic parameters categorizing patients as having bacteremia, infection, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, or multiple-organ-dysfunction syndrome (MODS).2 Standardized definitions have been developed for infections in critically ill patients.3... 

Septic shock Sepsis with hypotension, despite fluid resuscitation, along with the presence of perfusion abnormalities. Patients who are on inotropic or vasopressor agents may not be hypotensive at the time perfusion abnormalities are measured. Multiple-Organ Dysfunction Syndrome (MODS) Presence of altered organ function requiring intervention to maintain homeostasis. 

Multiparity Condition of having given birth to multiple children. Multiple organ dysfunction syndrome Relatively simultaneous failure of more than one organ, regardless of etiology. 

Multiple organ dysfunction syndrome Presence of altered organ dysfunction in an acutely ill patient such that homeostasis cannot be maintained without intervention. 

Fig. 1. Main steps in the pathogenesis of sepsis, leading to septic shock and/or multiple organ dysfunction syndrome (MODS).

Thiemermann, C., Ruetten, H., Wu, C. C., Vane, J. R., The multiple organ dysfunction syndrome caused by endotoxin in the rat attenuation of liver dysfunction by inhibitors of nitric oxide synthase, Br. /. Pharmacol. 116 (1995), p. 2845-2851... 

Carreras, M. C., Catz, S. D., Pargament, G. A., Del Bosco, C. G., and Poderoso, J. J. (1994a). Decreased production of nitric oxide by human neutrophils during septic multiple organ dysfunction syndrome. Inflammation 18, 151-161. 

It is, in part, the irreversibility of failure cascades that makes them so formidable. In medicine such failure cascades may be manifest as multiple organ dysfunction syndrome (MODS) that rapidly accumulates following a minor insult MODS is the leading cause of death in intensive care units. As Buchman [108] points out ... 

The layer upon layer of fractal redundancy in scale-free biological systems suggests that attack at one level does not place the organism at undue risk. But attack at vital transmission nodes can cause catastrophic failure of the system. The development of multiple organ dysfunction syndrome (MODS) in critically ill humans may be such a failure. Once devolved, death almost inevitably ensues. The similarity to concerted attack on vital Internet router nodes is evident. Patients managed by conventional non-fractal life support may sustain further unintentional attack on a devolving scale-free system due to loss of normal fractal transmission. Returning fractal transmission to life support devices may improve patient care and potentially offer benefit to the sickest of patients. 

T. G. Buchman, Physiologic failure Multiple organ dysfunction syndrome. Preprint. 

The criteria for the new terms provide specific physiologic variables that can be used to categorize a patient as having bacteremia, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, or multiple-organ-dysfunction syndrome (MODS),... 

Multiple-organ dysfunction syndrome (MODS) Compensatory anti-inflammatory response syndrome (CARS)... 

Skin bum is a traumatic injury causing changes in the systemic immune response and ranote organ injury (lung, kidney, gut, bone marrow). The suppression caused in the immune systan increases the susceptibility to infection facUi-tating the translocation of gut-derived bacteria and their products. Therefore, sepsis, systanic inflammatory response syndrome, and multiple organ dysfunction syndromes could develop in critically ill bum patients [62],... 

Figure 1 Algorithm for the management of patients with nosocomial pneumonia. Abbreviations CXR, chest X ray CPIS, clinical pulmonary infection score TEAS, tracheobronchial aspirate BAL, bronchoalveolar lavage PSB, protected specimen bmsh PaOa, oxygen arterial pressure Fi02, inspired fraction of oxygen MODS, multiple organ dysfunction syndrome.

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