What Is Multiple Organ Dysfunction Syndrome?

Multiple organ dysfunction syndrome (MODS) refers to the fact that the body has two or more organs or systems at the same time or sequentially during the acute illness such as severe trauma, shock, infection, and major surgical operations. A clinical syndrome in which dysfunction occurs so that the internal environment cannot be stabilized.

Basic Information

Visiting department: Infectious Diseases
Common causes: Any disease that causes a systemic inflammatory response can result.

Common symptoms: Dysfunction in two or more organs or systems simultaneously or sequentially.
Contagious: no

Causes of multiple organ dysfunction syndrome

MODS can occur in any disease that causes a systemic inflammatory response. Surgical diseases are common in the following:
1. Sepsis caused by various surgical infections.
2. Severe trauma, burns or major surgery leading to blood loss and water shortage.
3. Ischemia-reperfusion injury of limbs, large areas of tissues or organs caused by various reasons.
4. Shock for various reasons, after resuscitation of heartbeat, respiratory arrest.
5. Blood transfusion, infusion, medication or mechanical ventilation.
6. Acute abdomen with organ necrosis or infection.
7. Patients with certain diseases are more likely to develop MODS, such as chronic diseases of the heart, liver and kidney.

Clinical manifestations of multiple organ dysfunction syndrome

There are two types of clinical course of MODS.
1. Phase I rapid haircut Phase I rapid haircut refers to the simultaneous dysfunction of two or more organ systems after the onset of the primary emergency.
2. Second-phase late-onset type The second-phase late-onset type is the dysfunction of an important system or organ, which usually involves cardiovascular, renal, or pulmonary dysfunction. After a period of approximately stable, dysfunction of multiple organ systems occurs.

Multiple Organ Dysfunction Syndrome

1. Hematology examination (1) Acute anemia crisis: hemoglobin <50g / L.
(2) White blood cell count: The white blood cell count and neutrophils increased or decreased significantly during the infection (white blood cell count 2 × 109 / L).
(3) Platelet count: 20 × 109 / L.
2. Blood test (1) Progressive hypoxemia: PaCO2> 65mmHg, PaO2 <40mmHg, PaO2 / FiO2 <200mmHg.
(2) Prothrombin time (PT), partial thromboplastin time (APTT):> 1.5 times normal (3) Impaired renal function: Metabolite retention, electrolyte balance disorders, urea production capacity to exclude ammonia decreases, serum BUN35.7mmol / L, serum creatinine176.8mol / L.
(4) Impaired liver function: increased serum bilirubin, increased aspartate aminotransferase, increased alanine aminotransferase, increased lactate dehydrogenase, total bilirubin> 85.5 mol / L and aspartate aminotransferase (SGOT) or lactate dehydrogenase ( LDH) is more than twice the normal value.
(5) Detection indicators of hypoperfusion performance: blood lactate 2-10mmol / L, serum pH <7.2 (PaCO2 is not higher than normal value).
(6) Others: increased myocardial enzymes, low plasma protein synthesis, and increased ketone bodies.
3. Pathogenic bacteria inspection positive for infectious disease bacterial culture, viral nucleic acid test, etc.
4. Urine tests for changes in proteinuria, hematuria, etc.

Diagnosis of multiple organ dysfunction syndrome

According to the etiology and clinical manifestations, combined with various indicators of the cardiovascular system, respiratory system, nervous system, blood system, kidney system, gastrointestinal system, and liver system, a clear diagnosis can be made.
1. Cyclic systolic blood pressure is below 90 mmHg, and lasts for more than 1 hour, or requires drug support to stabilize circulation.
2. Acute onset of respiratory disease, arterial partial pressure of oxygen / inhaled oxygen concentration 200 mmHg (with or without positive end-expiratory pressure), X-ray orthotopic chest radiograph shows bilateral lung infiltration, pulmonary artery incarceration pressure 18 mmHg Or there is no evidence of increased left atrial pressure 3. Hepatic bilirubin> 34.1 mol / L, accompanied by elevated transaminase, more than twice the normal value, or hepatic encephalopathy.
4. Kidney serum creatinine> 176.8mol / L with oliguria or polyuria, or need blood purification treatment.
5. Gastrointestinal bleeding, gastrointestinal bleeding of more than 400 ml in 24 hours, or disappearance of gastrointestinal motility, intolerance of food, or gastrointestinal perforation or necrosis.
6. Metabolism cannot provide the body with the required energy, impaired glucose tolerance, and insulin is needed; or skeletal muscle atrophy, weakness and other symptoms appear.
7. Blood platelets <50x109 / L or 25% reduction, or disseminated intravascular coagulation.
8. Central nervous Glasgow coma score <7 points.

Multiple Organ Dysfunction Syndrome Treatment

1. Liquid resuscitation should be performed according to the etiology, and patients with hypovolemia should actively replenish fluids intravenously.
2. Blood pressure does not recover after vasoactive drugs are resuscitated. Dopamine is required to increase hypertension.
3. Control and prevent infection (1) Reasonable use of antibiotics. For those suspected of sepsis, blood or other specimens should be taken immediately.
(2) Strengthen ward management and strictly aseptic operation.
4. The use of activated protein C in immunotherapy can significantly reduce the mortality of patients.
5. Organ function support (1) Circulation support: Patients with this disease are prone to acute cardiac insufficiency or acute pulmonary edema, and treatment should be given to reduce the pre- and post-load of the heart and enhance myocardial contractility. Those with conditions can use mechanical assisted circulation.
(2) Respiratory support: keep the airway open, give patients oxygen therapy, and give mechanical ventilation if necessary.
(3) Renal support: For patients with acute renal failure, maintain blood pressure and ensure renal perfusion.
(4) Liver support: supplement appropriate calories, proteins and energy substances; avoid using drugs that are harmful to the liver; liver replacement therapy.
(5) Nutritional support: Take enteral nutritional support as much as possible to reduce cholestasis and protect the gastrointestinal mucosal barrier function.
6. Anti-inflammatory treatment: preventive application of antibiotics, or targeted application of high-efficiency, broad-spectrum antibiotics to control severe systemic infections.