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KEY POINTS

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KEY POINTS

  1. Multiorgan dysfunction syndrome (MODS) is common in critically ill patients and associated with a high mortality rate.

  2. There are many underlying etiologies of MODS. In the overall intensive care unit (ICU) population, sepsis is the most common cause of MODS.

  3. MODS is characterized by dysfunction of two or more organs or systems.

  4. Inflammation and microvascular abnormalities are involved in the development of MODS.

  5. Therapies for MODS should target the underlying cause, support the patient, and correct the physiologic and metabolic derangements caused by organ dysfunction.

  6. Patients with MODS often require surgery and other invasive procedures.

  7. Preoperative optimization should be dictated by the affected organs and the severity of physiologic and metabolic derangements.

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INTRODUCTION

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Progress in life support therapies has led to the recognition of pathophysiologic states that are unique to critically ill patients. Diverse disease states can cause progressive dysfunction and ultimately complete failure of various organs and systems. This condition is referred to as the multiorgan dysfunction syndrome (MODS). High-grade organ failure that necessitates life-sustaining therapies is often referred to as multiorgan system failure. The development of MODS portends a poor outcome and is one of the leading causes of death for ICU patients.1,2 This chapter reviews basic aspects of MODS, surgical and nonsurgical procedures that are commonly performed in patients with MODS, and the preoperative preparation and optimization of MODS patients for surgery.

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MULTIORGAN DYSFUNCTION SYNDROME

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The development of organ dysfunction as a separate disease process from the initial injury was first appreciated during World War II. Wounded soldiers were rapidly and aggressively resuscitated with blood products to normalize blood pressure, and they were more promptly evacuated to medical facilities than in previous wars. Although initial survival was improved, many soldiers subsequently died of renal failure.3,4 This led to changes in fluid resuscitation practices including the rapid infusion of crystalloids and more aggressive resuscitation. During the Vietnam War, many soldiers who survived their initial trauma developed “shock lung” (acute respiratory failure). At the same time, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) were increasingly being described in civilian ICUs.5 During the 1970s, advances in critical care medicine led to improved initial survival from many injuries. However, many of those who survived initial resuscitation went on to develop progressive failure of various organs and systems.6,7

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Various terms have been used to describe the spectrum of dysfunction of different organs and systems (reviewed in Bone et al8), including multiple organ failure,9 multiple-organ-failure syndrome,1 multiple system organ failure,10 progressive or sequential organ failure,6 or MODS.8,11 The acronym MODS is most widely used and encompasses the spectrum from mild organ dysfunction to complete organ failure. In addition, scoring systems have been devised to assess patients and to ...

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