Skip to Main Content

++

  1. Multiple organ 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 2 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, supporting the patient and correcting the physiologic and metabolic derangements caused by dysfunction of the organs and systems.

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

  7. Whenever possible, optimize MODS patients preoperatively.

  8. Methods of optimization are dictated by the affected organs and the severity of physiologic and metabolic derangements.

++

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 commonly referred to as the multiple organ 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. In fact, MODS 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.

++

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 who survived the initial trauma subsequently died of renal failure.3,4 This led to changes in fluid resuscitation practices in subsequent wars, 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 patients who survived initial resuscitation went on to develop progressive failure of various organs and systems.6,7

++

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 term 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 predict outcome.4,12-16 In this chapter the ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.