1、Multiple Organ Dysfunction Syndrome (MODS)多器官功能障碍综合征Lecturer Dr. Xianmin Bu 卜献民Definition Multiple organ dysfunction syndrome MODS: Multiple organs or systems dysfunction occur simultaneously or progressively following severe infection, severe trauma and shock. The affected organs/systems may be res
2、piratory, cardiovascular, renal, hepatic, gastrointestinal, hematological, endocrine, and central nervous system. MODS is an important reason for the death of severe patient.The Evolution of MODS In World War I, injured soldiers died in the battlefield of profound cardiac failure. This was presumed
3、to be caused by wound toxins, but clinical interventions were largely undefined. In World War II and to a greater extent in the Korean War, the loss of blood volume was recognized to be the primary cause of traumatic shock. battlefield casualties were resuscitated with blood and plasma until blood p
4、ressure returned to normal. As a result, more soldiers survived their initial insult; however, the severely injured often succumbed to oliguric renal failure. The Evolution of MODS 1960s - ARDS was described in Vietnam “Shock Lung”. 1973 - Tilney described multiple organ failure (MOF) or Multi Syste
5、m Organ Failure (MSOF). They concluded that MOF syndrome was the result of a combination of preexisting disease and hemorrhagic shock. 1980s - began to realize concept of sepsis. MOF was considered as a fatal expression of uncontrolled infection. 1990s systemic hyperinflammation became the focus, no
6、w referred to as the systemic inflammation response syndrome (SIRS). The Evolution of MODS MODS replaces “Multi System Organ Failure” or MSOF MODS is a range of dysfunctional organs, not just failure Altered organ function in an acutely ill patient such that homeostasis cannot be maintained without
7、interventionMOF and MODS Multiple organ failure (MOF):Progressive distant organ failure (initially uninvolved) following severe infectious or noninfectious insults (severe burn, multiple trauma, shock, acute pancreatitis) MOF is the finality of MODSmechanism basis diseases:1. Severe tissue injury or
8、 blood and fluid loss due to trauma, burn and major operation2. Severe infection3. Shock4. resuscitation of cardiac and respiratory arrest5. Acute haemorrhagic necrotic pancreatitis, colic intestine obstruction, rewarming of cold injury6. Misapplication of infusion, drug, or respirator.7. Primary di
9、sease: coronary heart disease, liver cirrhosis, chronic nephrosismechanismThe mechanisms of MODS are enormously compiex and poorly understood.Systemic inflammatory response syndrome (SIRS) is the main reason of MODS. Definition: pathologic inflammatory response to injury or infection Diagnostic crit
10、eria:any two or more of the following manifestations:1.temp 38 or 90/min3.respiratory rate 20/min or hyperventilation (PaCO2 12,000 cells/mm3,or 10% mechanism To every action there is always opposed an equal reaction: or, the mutual action of two bodies upon each other are always equal, and directed to contrary parts.-Sir Isaac Newton, 1687 Compensatory anti-inflammatory response syndrome (CARS) Imbalance of inflammatary response and anti-inflammatory response SIRS CARS, MODS occurs.
