Page 585 - ACCCN's Critical Care Nursing

21 Multiple Organ Dysfunction

Syndrome

Melanie Greenwood
Alison Juers

also affects physiological systems such as the haemato-
Learning objectives logical, immune and endocrine systems. MODS therefore
more accurately describes altered organ function in a
After reading this chapter, you should be able to: critically ill patient who requires medical and nursing
● define the common terminology related to multiple organ interventions to achieve homeostasis. 4
dysfunction syndrome MODS is associated with widespread endothelial and
● describe the related pathophysiology of multiple organ parenchymal cell injury because of hypoxic hypoxia,
dysfunction syndrome direct cytotoxicity, apoptosis, immunosuppression and
● identify the clinical manifestations of multiple organ coagulopathy. Four clinical stages describe a patient with
4
dysfunction syndrome developing MODS: 5
● identify patients at risk of developing multiple organ 1. increasing volume requirements and mild respira-
dysfunction, including predictors of mortality tory alkalosis, accompanied by oliguria, hypergly-
● initiate appropriate monitoring, care planning and caemia and increased insulin requirements
evaluation strategies for the patient with multiple organ 2. tachypnoea, hypocapnia and hypoxaemia, with
dysfunction in relation to the current evidence base moderate liver dysfunction and possible haemato-
● discuss treatment strategies that promote homeostasis in logical abnormalities
the patient with multiple organ dysfunction syndrome 3. developing shock with azotaemia, acid–base
disturbances and significant coagulation
abnormalities
4. vasopressor dependence with oliguria or anuria,
ischaemic colitis and lactic acidosis.
Key words
Cellular damage in various organs in patients who
cytokines/mediators develop MODS begins with the onset of local injury that
multiple organ dysfunction syndrome is then compounded by activation of the innate immune
system. This includes a combination of pattern recogni-
multiple organ failure tion, receptor activation and release of mediators at the
sepsis microcellular level, leading to episodes of hypotension or
apoptosis hypoxaemia and secondary infections. The primary
4,5
inflammation therapeutic goal for nursing and medical staff is prompt,
procoagulation definitive control of the source of infection or pro-
inflammation and early recognition of preexisting factors
6
that may lead to subsequent organ damage away from the
initial site of injury. This preemptive therapy is instituted
INTRODUCTION to maintain adequate tissue perfusion and prevent the
onset of MODS. Recognition and response to early signs
The term multiple organ dysfunction syndrome (MODS) of clinical deterioration are therefore important to mini-
was established by an expert consensus conference in mise further organ dysfunction.
1992 to describe a continuum of physiologic derange-
ments and subsequent dynamic alterations in organ func- This chapter initially describes the pathophysiology of
1,2
tion that may occur during a critical illness. Previous inflammatory and infective conditions that may lead to
terminologies in the literature were confusing. For multiple organ dysfunction. System responses and spe-
example, multiple organ failure (MOF) was a term com- cific organ dysfunction are discussed, expanding on dia-
monly used, but somewhat misleading as normal physio- logue in previous chapters, particularly Chapters 19 and
logic function can, in most cases, be restored in survivors 20. Assessment of the severity of MODS and nursing
of a critical illness who have temporary organ dysfunc- considerations in the treatment of the MODS patient is
3,4
562 tion. Although the syndrome affects many organs, it presented.