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Multiple Organ Dysfunction Syndrome

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Pediatric Critical Care Medicine

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Abstract

Multiple organ dysfunction syndrome (MODS) occurs after a life-threatening primary insult, including severe infection, hypoxic-ischemic injury, or other serious injuries. It represents a continuum of physiological abnormalities rather than a distinct state (present or absent). Young age and chronic health conditions are the most important risk factors for the development of MODS. Increasing number of dysfunctional organs is correlated with mortality, greater use of resources, and prolonged stay in pediatric intensive care units. Severe insults converge towards a common systemic response resulting in organ dysfunctions, yet the underlying mechanism remains ill-defined. Acute illnesses may trigger severe inflammatory response resulting in cytokine liberation, activation of coagulation, development of shock and capillary leak. Most experimental therapies to date have focused on attenuating the initial inflammatory response with little benefits in humans. As the initial inflammatory storm subsides, relative immune suppression becomes a major contributor to the disease process. Consequently, MODS patients are highly vulnerable to nosocomial infections. Metabolic demands and neuroendocrine responses also follow a similar seesaw pattern of over-activation followed by a state of relative suppression. Therefore, MODS may emerge from the cumulative suppression of metabolic, neuroendocrine, and immune functions resembling a state of dormancy, hypothesized to be an evolutionary protective cellular mechanism in response to overwhelming injuries. Diagnosis of MODS should encourage physicians to uncover the underlying etiology that may require a specific therapy. The symptomatic management of organ dysfunctions must be carefully assessed in the context of systemic interactions with other failing organs. Although long term outcome data of critically ill children with MODS is limited, 60 % of survivors are reported to have a normal quality of life with minimal health problems.

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Authors and Affiliations

  1. Department of Pediatrics, Sainte-Justine, 3175 Chemin Côte Sainte Catherine, Montreal, Québec, H3T 1C5, Canada

    François Proulx MD, Jean Sébastien Joyal MD, PhD & Philippe Jouvet MD, PhD

  2. Department of Pediatrics, Jeanne de Flandre, Avenue Eugène Avinée, Lille, France

    Stéphane Leteurtre MD, PhD

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  1. François Proulx MD
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  2. Stéphane Leteurtre MD, PhD
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  3. Jean Sébastien Joyal MD, PhD
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  4. Philippe Jouvet MD, PhD
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Correspondence to François Proulx MD .

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  1. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Proulx, F., Leteurtre, S., Joyal, J.S., Jouvet, P. (2014). Multiple Organ Dysfunction Syndrome. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6362-6_35

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