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Multiorgan Dysfunction Syndrome (MODS): What is New?

  • Jean-Louis VincentEmail author
  • Marjorie Beumier
  • Antoine Herpain
  • Katia Donadello
Chapter
  • 2.3k Downloads

Abstract

Multiorgan dysfunction syndrome (MODS) was defined by the ACCP/SCCM conference almost 20 years ago as the situation in an acutely ill patient whereby organ function is disrupted such that it is unable to maintain homeostasis. Importantly, MODS is a dynamic process, changing over time according to various host-related factors and as the patient responds (or not) to therapeutic interventions. In this chapter, we will discuss some of the current concepts surrounding MODS, and highlight recent advances in our understanding of the pathophysiology and treatment for this condition.

Keywords

Organ Failure Mean Arterial Pressure Organ Dysfunction Intensive Care Unit Patient Sequential Organ Failure Assessment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abraham E, Singer M (2007) Mechanisms of sepsis-induced organ dysfunction. Crit Care Med 35:2408–2416PubMedCrossRefGoogle Scholar
  2. Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709PubMedCrossRefGoogle Scholar
  3. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655PubMedCrossRefGoogle Scholar
  4. Clark JA, Coopersmith CM (2007) Intestinal crosstalk: a new paradigm for understanding the gut as the “motor” of critical illness. Shock 28:384–393PubMedCrossRefGoogle Scholar
  5. De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, Vincent JL (2006a) The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 34:403–408PubMedCrossRefGoogle Scholar
  6. De Backer D, Verdant C, Chierego M, Koch M, Gullo A, Vincent JL (2006b) Effects of drotrecogin alfa activated on microcirculatory alterations in patients with severe sepsis. Crit Care Med 34:1918–1924PubMedCrossRefGoogle Scholar
  7. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36:296–327PubMedCrossRefGoogle Scholar
  8. Endo S, Aikawa N, Fujishima S, Sekine I, Kogawa K, Yamamoto Y, Kushimoto S, Yukioka H, Kato N, Totsuka K, Kikuchi K, Ikeda T, Ikeda K, Yamada H, Harada K, Satomura S (2008) Usefulness of procalcitonin serum level for the discrimination of severe sepsis from sepsis: a multicenter prospective study. J Infect Chemother 14:244–249PubMedCrossRefGoogle Scholar
  9. Guidet B, Aegerter P, Gauzit R, Meshaka P, Dreyfuss D (2005) Incidence and impact of organ dysfunctions associated with sepsis. Chest 127:942–951PubMedCrossRefGoogle Scholar
  10. Jansen TC, van Bommel J, Woodward R, Mulder PG, Bakker J (2009) Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study. Crit Care Med 37:2369–2374PubMedCrossRefGoogle Scholar
  11. Li X, Hassoun HT, Santora R, Rabb H (2009) Organ crosstalk: the role of the kidney. Curr Opin Crit Care 15:481–487PubMedCrossRefGoogle Scholar
  12. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Melot C, Vincent JL (2003) C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest 123:2043–2049PubMedCrossRefGoogle Scholar
  13. Lobo SM, Rezende E, Knibel MF, Silva NB, Paramo JA, Nacul FE, Mendes CL, Assuncao M, Costa RC, Grion CC, Pinto SF, Mello PM, Maia MO, Duarte PA, Gutierrez F, Silva JJ, Lopes MR, Mellot C (2011) Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients. Anesth Analg 112(4):877–883PubMedCrossRefGoogle Scholar
  14. Mayr VD, Dunser MW, Greil V, Jochberger S, Luckner G, Ulmer H, Friesenecker BE, Takala J, Hasibeder WR (2006) Causes of death and determinants of outcome in critically ill patients. Crit Care 10:R154PubMedCrossRefGoogle Scholar
  15. Ospina-Tascon G, Neves AP, Occhipinti G, Donadello K, Buchele G, Simion D, Chierego ML, Silva TO, Fonseca A, Vincent JL, De Backer D (2010) Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med 36:949–955PubMedCrossRefGoogle Scholar
  16. Rice TW (2009) Omega-3 (n-3) fatty acid, gamma-linolenic acid (GLA) and anti-oxidant supplementation in acute lung injury (OMEGA trial) (abstract). Crit Care Med 37:A408Google Scholar
  17. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRefGoogle Scholar
  18. Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32:1825–1831PubMedCrossRefGoogle Scholar
  19. Sakr Y, Chierego M, Piagnerelli M, Verdant C, Dubois MJ, Koch M, Creteur J, Gullo A, Vincent JL, De Backer D (2007) Microvascular response to red blood cell transfusion in patients with severe sepsis. Crit Care Med 35:1639–1644PubMedCrossRefGoogle Scholar
  20. Shapiro N, Howell MD, Bates DW, Angus DC, Ngo L, Talmor D (2006) The association of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infection. Ann Emerg Med 48:583–590, 590PubMedCrossRefGoogle Scholar
  21. Ugarte H, Silva E, Mercan D, De Mendonca A, Vincent JL (1999) Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 27:498–504PubMedCrossRefGoogle Scholar
  22. Vincent JL (2009) Sepsis: clearing the blood in sepsis. Nat Rev Nephrol 5:559–560PubMedCrossRefGoogle Scholar
  23. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353PubMedCrossRefGoogle Scholar
  24. Ympa YP, Sakr Y, Reinhart K, Vincent JL (2005) Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med 118:827–832PubMedCrossRefGoogle Scholar
  25. Zambon M, Vincent JL (2008) Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest 133:1120–1127PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Jean-Louis Vincent
    • 1
    Email author
  • Marjorie Beumier
    • 1
  • Antoine Herpain
    • 1
  • Katia Donadello
    • 1
  1. 1.Department of Intensive Care, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium

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