Makindo Medical Notes.com

Related Subjects: |Respiratory Failure |Non-invasive ventilation (NIV) |Intubation and Mechanical Ventilation |Critical illness neuromuscular weakness |Multiple Organ Dysfunction Syndrome |Haemodialysis |Dobutamine

About

• MODS is clinically defined as the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention.
• It usually involves two or more organ systems; respiratory distress is most common, followed by hepatic damage, gastrointestinal bleeding, and renal dysfunction.

Types

• Primary MODS is organ dysfunction caused by an initial disease or infectious process resulting in injury to an organ system.
• Secondary MODS is organ dysfunction caused by the systemic inflammatory response syndrome or sepsis

Causes

• Shock due to Sepsis
• Shock due to Haemorrhage
• Shock due to Circulatory failure
• Blood transfusion of incompatible blood
• Trauma
• Abdominal compartment syndrome

Risks

• Advanced age
• Increased body mass index (BMI)
• Male sex
• Injury severity score
• Base deficit on admission.

Aetiology

• Hypoxia and hypoperfusion

Clinical

• Depression, lethargy
• Injected mucous membranes, increased capillary refill time
• Tachycardia or bradycardia, poor pulse quality, cool extremities
• Tachypnea, Decreased borborygmi, decreased fecal output, colic
• Fever or hypothermia

By Organ

• Cardiac dysfunction: inotropes, intra-aortic balloon pumps, left ventricular assist devices for heart failure
• Respiratory failure: Oxygen, HDU and mechanical ventilation for acute respiratory failure
• Immunity: High risk of sepsis.
• Gut: intestinal mucosa is damaged with ischaemia and ulceration commonly occur with toxins entering the portal circulation. Normal food intake where possible. NG feeding if functioning. PPI. TPN as a last resort. Manage sugars.
• Liver: Liver dysfunction due to shock with necrosis, hypoglycaemia, deranged LFTs and lactic acidosis. May be hyperbilirubinaemia due to (non-calculous) cholecystitis and cholestasis. Transaminitis may be a drug toxicity.
• CNS: Reduced GCS, Delirium. Need regular turns to protect skin. May have muscle wasting and critical care neuropathy
• Endocrine: may be adrenal dysfunction, abnormal glucose needing insulin.
• Renal: AKI due to uncorrected hypovolaemia, hypotension or ischaemia. May cause Acute tubular necrosis (ATN) due to ischaemia, bacterial or chemical toxins. NSAIDs or radiological contrast media can cause or exacerbate AKI. Ultimately continuous renal replacement therapy or dialysis for AKI
• Bone Marrow: Anaemia is common in the ICU, with estimates that 30% to 50%. Due to bleeding, chronic disease, renal failure, haemolysis. In non-bleeding patient a restrictive transfusion strategy (i.e., only transfusing patients with blood if their haemoglobin is less than 70 g/L, or less than 80 g/L if patient has IHD
• Clotting: Disseminated intravascular coagulation can be seen with ↑ prothrombin time ↑ partial ↑ thromboplastin time ↑ fibrin degradation products, and ↓ platelets and fibrinogen. May be bleeding from vascular access points, GI tract, bronchial tree and surgical wound sites, or widespread evidence of thrombosis. Give fresh frozen plasma and platelets, while the underlying cause is treated.
• Low platelets: keep counts > 50,000/µL. If the bleeding is intracranial or a neurosurgical intervention is being planned, the goal should be 100,000/µL.

References