Surgical Critical Care: Multiple Organ Dysfunction Syndrome (MODS)

Definitions

• Multiple Organ Dysfunction Syndrome (MODS): Development of Potentially Reversible Physiologic Derangements Involving ≥ 2 Organ Systems Not Directly Involved in the Primary Disorder Causing ICU Admission
  • Multiple Organ Failure (MOF) – Older Term Indicating Complete Organ Failure (No Longer Used)
• Classification:
  • Primary MODS – Organ Dysfunction Directly Caused by an Insult Itself
  • Secondary MODS – Organ Dysfunction Caused by the Host Response to an Insult

Causes

• Infection (Sepsis & Septic Shock)
• Systemic Inflammatory Response Syndrome (SIRS)
  • Pancreatitis
  • Aspiration
  • Ischemia-Reperfusion Injury
• Major Trauma or Burns

Common Dysfunctions

• Acute Respiratory Distress Syndrome (ARDS)
• Cardiomyopathy & Heart Failure
• Acute Kidney Injury (AKI)
• Encephalopathy
• Liver Dysfunction
• Disseminated Intravascular Coagulation (DIC)
• Coagulopathy
• Bone Marrow Suppression
• Stress Ulceration
• Paralytic Ileus
• Intestinal Ischemia
• Pancreatitis
• Acalculous Cholecystitis

Post-Traumatic Pattern

• Primary Risk Factors:
  • Early Dysfunction: Shock
  • Late Dysfunction: Infection
• Patterns of Dysfunction:
  • Early Dysfunction: Pulmonary & Cardiac Failure
  • Late Dysfunction: Pulmonary & Hepatic Failure

Prognosis

• Associated with High Mortality Rates
• 0 Failing Organ Systems: < 10%
• 1 Failing Organ Systems: 0-30%
• 2 Failing Organ Systems: 20-50%
• 3 Failing Organ Systems: 40-80%
• 4 Failing Organ Systems: 60-100%
• ≥ 5 Failing Organ Systems: 80-100%