scholarly journals Refining the Pediatric Multiple Organ Dysfunction Syndrome

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S13-S22
Author(s):  
Scott L. Weiss ◽  
Joseph A. Carcillo ◽  
Francis Leclerc ◽  
Stephane Leteurtre ◽  
Luregn J. Schlapbach ◽  
...  
Keyword(s):  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Time Course ◽  
Research Priorities ◽  
Multiple Organ ◽  
Common Mechanism ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Organ Specific ◽  
Pathologic State

Since its introduction into the medical literature in the 1970s, the term multiple organ dysfunction syndrome (or some variant) has been applied broadly to any patient with >1 concurrent organ dysfunction. However, the epidemiology, mechanisms, time course, and outcomes among children with multiple organ dysfunction vary substantially. We posit that the term pediatric multiple organ dysfunction syndrome (or MODS) should be reserved for patients with a systemic pathologic state resulting from a common mechanism (or mechanisms) that affects numerous organ systems simultaneously. In contrast, children in whom organ injuries are attributable to distinct mechanisms should be considered to have additive organ system dysfunctions but not the syndrome of MODS. Although such differentiation may not always be possible with current scientific knowledge, we make the case for how attempts to differentiate multiple organ dysfunction from other states of additive organ dysfunctions can help to evolve clinical and research priorities in diagnosis, monitoring, and therapy from largely organ-specific to more holistic strategies.

Multiple Organ Dysfunction Syndrome

2015 ◽  
Author(s):  
Vishal Bansal ◽  
Jay Doucet
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Ultimate Outcome

The concept of and approach to multiple organ dysfunction syndrome (MODS), also known as progressive systems failure, multiple organ failure, and multiple system organ failure, have evolved over the last decade. Characterized by progressive but potentially reversible tissue damage and dysfunction of two or more organ systems that arise after a significant physiologic insult and its subsequent management, MODS evolves in the wake of a profound disruption of systemic homeostasis. Pre-existing illness, nutritional status, hospital course, and genetic variation all lead to the development of organ dysfunction in patients exposed to these risk factors. The ultimate outcome from MODS is influenced not only by a patient’s genetic and biological predisposition but also by specific management principles practiced by intensivists. This review details the clinical definitions, quantification, prevention, evaluation, support, and outcomes of organ dysfunction. A figure shows the increasing severity of organ dysfunction correlated with increasing intensive care unit mortality, and an algorithm details the approach to MODS. Tables list risk factors and prognosis for MODS, the multiple organ dysfunction (MOD) score, the sequential organ failure assessment (SOFA) score, intensive care unit interventions that reduce mortality or attenuate organ dysfunction along with unproven or disproven ICU interventions, and the temporal evolution of MODS. This review contains 1 figure, 7 tables, and 159 references.

Multiple Organ Dysfunction Syndrome

2015 ◽  
Author(s):  
Vishal Bansal ◽  
Jay Doucet
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Ultimate Outcome

The concept of and approach to multiple organ dysfunction syndrome (MODS), also known as progressive systems failure, multiple organ failure, and multiple system organ failure, have evolved over the last decade. Characterized by progressive but potentially reversible tissue damage and dysfunction of two or more organ systems that arise after a significant physiologic insult and its subsequent management, MODS evolves in the wake of a profound disruption of systemic homeostasis. Pre-existing illness, nutritional status, hospital course, and genetic variation all lead to the development of organ dysfunction in patients exposed to these risk factors. The ultimate outcome from MODS is influenced not only by a patient’s genetic and biological predisposition but also by specific management principles practiced by intensivists. This review details the clinical definitions, quantification, prevention, evaluation, support, and outcomes of organ dysfunction. A figure shows the increasing severity of organ dysfunction correlated with increasing intensive care unit mortality, and an algorithm details the approach to MODS. Tables list risk factors and prognosis for MODS, the multiple organ dysfunction (MOD) score, the sequential organ failure assessment (SOFA) score, intensive care unit interventions that reduce mortality or attenuate organ dysfunction along with unproven or disproven ICU interventions, and the temporal evolution of MODS. This review contains 1 figure, 7 tables, and 159 references.

Multiple Organ Dysfunction Syndrome

2015 ◽  
Author(s):  
Vishal Bansal ◽  
Jay Doucet
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Ultimate Outcome

The concept of and approach to multiple organ dysfunction syndrome (MODS), also known as progressive systems failure, multiple organ failure, and multiple system organ failure, have evolved over the last decade. Characterized by progressive but potentially reversible tissue damage and dysfunction of two or more organ systems that arise after a significant physiologic insult and its subsequent management, MODS evolves in the wake of a profound disruption of systemic homeostasis. Pre-existing illness, nutritional status, hospital course, and genetic variation all lead to the development of organ dysfunction in patients exposed to these risk factors. The ultimate outcome from MODS is influenced not only by a patient’s genetic and biological predisposition but also by specific management principles practiced by intensivists. This review details the clinical definitions, quantification, prevention, evaluation, support, and outcomes of organ dysfunction. A figure shows the increasing severity of organ dysfunction correlated with increasing intensive care unit mortality, and an algorithm details the approach to MODS. Tables list risk factors and prognosis for MODS, the multiple organ dysfunction (MOD) score, the sequential organ failure assessment (SOFA) score, intensive care unit interventions that reduce mortality or attenuate organ dysfunction along with unproven or disproven ICU interventions, and the temporal evolution of MODS. This review contains 1 figure, 7 tables, and 159 references.

A New Scoring System For Evaluation of Multiple Organ Dysfunction Syndrome in Premature Infants

2012 ◽  
Vol 21 (5) ◽  
pp. 328-337 ◽  
Author(s):  
Merih Çetinkaya ◽  
Nilgün Köksal ◽  
Hilal Özkan
Keyword(s):  
Organ Dysfunction ◽  
Premature Infants ◽  
Multiple Organ Dysfunction Syndrome ◽  
Respiratory System ◽  
Scoring System ◽  
Multiple Organ ◽  
Gastrointestinal System ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
The Mean

Background The Neonatal Multiple Organ Dysfunction (NEO-MOD) scoring system is used to predict mortality in infants with multiple organ dysfunction syndrome (MODS). The NEOMOD scoring system was extended to include involvement of the microvascular system. This modified scoring system was developed to enable more accurate and earlier diagnosis of MODS in premature infants. Objective To evaluate the modified NEOMOD scoring system in preterm infants with MODS and compare its effectiveness with the NEOMOD scoring system. Methods This prospective study was performed in a tertiary neonatal intensive care unit. A total of 198 premature infants were enrolled. Infants were evaluated for development of MODS by using the modified NEOMOD scoring system until discharge or death according to clinical and laboratory findings. Infants who had organ dysfunction in 2 or more organ systems had MODS diagnosed. Results In the 160 infants (80.8%) with MODS, the gastrointestinal system, respiratory system, and hematologic system were involved most often. The gastrointestinal system, respiratory system, and acid-base metabolism were involved initially in 99.4%, 86.3%, and 26.3% of infants, respectively. The mean modified NEOMOD score for the infants who died in the first 28 days after birth was significantly higher than the mean score for infants who survived. The number of systems involved was also higher in infants who died. Conclusions The modified NEOMOD scoring system is a safe and accurate tool for determining both mortality rate and dysfunction of multiple organ systems affecting mortality in pre-term infants.

scholarly journals Intraabdominalinė hipertenzija ir pilvo suspaudimo sindromas: diagnostika, įtaka organų veiklai ir gydymas

2014 ◽  
Vol 13 (1) ◽  
pp. 7-18
Author(s):  
Mindaugas Šerpytis ◽  
Jurij Šabliauskas ◽  
Nadežda Ščupakova ◽  
Jūratė Šipylaitė ◽  
Kęstutis Strupas
Keyword(s):  
Compartment Syndrome ◽  
Organ Dysfunction ◽  
Abdominal Compartment Syndrome ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Abdominal Pressure ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

Dauginis organų nepakankamumo sindromas yra viena iš pagrindinių reanimacijos ir intensyviosios terapijos skyrių ligonių mirties priežasčių. Didėjant pažeistų organų sistemų skaičiui didėja ir mirštamumas. Nors pasiekta didelė pažanga gydant dauginį organų nepakankamumo sindromą (šiuolaikiniai dirbtinės plaučių ventiliacijos režimai, inkstų, kepenų pakaitinės terapijos metodai, ekstrakorporinė membraninė oksigenacija ir kiti gydymo būdai), tačiau ligonių, turinčių daugiau nei keturių organų nepakankamumą, mirštamumas viršija 70 % Todėl tikslinga daugiau dėmesio skirti organų nepakankamumo prevencijai ir ankstyvam kritinės būklės atpažinimui. Žalingas padidėjusio intraabdominalinio spaudimo poveikis visoms organų sistemoms yra įrodytas tiek eksperimentiniais tyrimais su gyvūnais, tiek klinikiniais tyrimais. Intraabdominalinė hipertenzija atlieka svarbų vaidmenį dauginio organų disfunkcijos sindromo patogenezėje, todėl intaabdominalinio spaudimo matavimas tapo rutininiu sunkios būklės ligonių stebėsenos rodikliu. Šioje apžvalgoje, remiantis naujausios literatūros duomenimis, apibendrinami intraabdominalinės hipertenzijos ir pilvo suspaudimo sindromo apibrėžimai, etiologija ir rizikos veiksniai, taip pat įvairūs intraabdominalinio spaudimo matavimo metodai, aptariamas intraabdominalinės hipertenzijos poveikis organų funkcijoms ir šiuolaikinės jos gydymo tendencijos.Reikšminiai žodžiai: intraabdominalinė hipertenzija, intraabdominalinis spaudimas, pilvo suspaudimo sindromas, dauginis organų disfunkcijos sindromas, dekompresinė laparotomija.Intra-abdominal hypertension and the abdominal compartment syndrome: diagnostics, effects on organ function and management The multiple organ dysfunction syndrome is one of the main causes of death in intensive care units. The more organ systems are injured the higher are mortality rates. Although there has been a significant progress in treating the multiple organ dysfunction syndrome (modern modes of mechanical lung ventilation, kidney, liver replacement therapy, extracorporeal membrane oxygenation and other techniques), the mortality rate in patients with more than four organ failures exceeds 70%. Therefore, it is reasonable to pay more attention to the prevention and early recognition of a critical illness. When the measurement of intra-abdominal pressure gradually became available in day-to-day practice, an increasing number of experimental animal testing and clinical trials have proved detrimental effects of the elevated intra-abdominal pressure on all organ systems and its role in the pathogenesis of the multiple organ dysfunction syndrome. In this review, we summarize the current literature data concerning the definitions, etiology and risk factors of intra-abdominal hypertension and the abdominal compartment syndrome as well as different techniques to measure the intra-abdominal pressure. We also discuss the pathophysiological implications of intra-abdominal hypertension on organ function and current treatment trends.Key words: intra-abdominal hypertension, intra-abdominal pressure, abdominal compartment syndrome, multiple organ dysfunction syndrome, decompressive laparotomy

scholarly journals Time Course of Early and Late Changes in Plasma DNA in Trauma Patients

2003 ◽  
Vol 49 (8) ◽  
pp. 1286-1291 ◽  
Author(s):  
Nicole Y L Lam ◽  
Timothy H Rainer ◽  
Lisa Y S Chan ◽  
Gavin M Joynt ◽  
Y M Dennis Lo
Keyword(s):  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Time Course ◽  
Temporal Changes ◽  
Multiple Organ ◽  
Trauma Patients ◽  
Multiple Organ Dysfunction ◽  
Plasma Dna ◽  
Severe Injuries

Abstract Background: Cell-free DNA concentrations increase in the circulation of patients after trauma and may have prognostic potential, but little is know concerning the temporal changes or clearance of the DNA or its relationships with posttraumatic complications. We investigated temporal changes in plasma DNA concentrations in patients after trauma with use of real-time quantitative PCR. Methods: Serial plasma samples were taken from two trauma populations. In the first study, samples were collected every 20 min from 25 patients within the first 3 h of trauma. In the second study, samples were collected every day from 36 other trauma patients admitted to the intensive care unit (ICU). Results: In the first study, plasma DNA was increased within 20 min of injury and was significantly higher in patients with severe injury and in patients who went on to develop organ failure. In patients with less severe injuries, plasma DNA concentrations decreased toward reference values within 3 h. In the second study, plasma DNA concentrations were higher in patients who developed multiple organ dysfunction syndrome between the second and fourth days of admission than in patients who did not develop the syndrome. In patients who remained in the ICU with continuing organ dysfunction, plasma DNA remained higher than in healthy controls even at 28 days after injury. Most survivors with multiple organ dysfunction syndrome showed an initial very high peak followed by a prolonged smaller increase. Conclusions: Plasma DNA concentrations increase early after injury and are higher in patients with severe injuries and in those who develop organ failure. Increased plasma DNA persists for days after injuries, especially in patients with multiple organ dysfunction syndrome.

Multiple Organ Dysfunction Syndrome of Alcoholic Origin in an 18-Year-Old Patient

2018 ◽  
Vol 2 (12) ◽  
Author(s):  
Francesco Gazia ◽  
Giacomo De Luca ◽  
Imbalzano Gabriele ◽  
Vincenzo Pellicanò
Keyword(s):  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction

IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury

2019 ◽  
Vol 131 (6) ◽  
pp. 1931-1937 ◽  
Author(s):  
Sungho Lee ◽  
Hyunsoo Hwang ◽  
Jose-Miguel Yamal ◽  
J. Clay Goodman ◽  
Imoigele P. Aisiku ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Sofa Score ◽  
Plasma Concentrations ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Poor Outcome ◽  
Initial Plasma

OBJECTIVETraumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODSThe authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTSTwo hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94–42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)–6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20–1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01–1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24–2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18–19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06–1.40, p = 0.006).CONCLUSIONSAdmission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.

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