Multiple Organ Dysfunction Syndrome

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Multiple Organ Dysfunction Syndrome
Pathophysiology Department, Tongji
Medical College, HUST
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World War One Circulatory failure, hypovolemic
shock
World War Two Korean War Post-traumatic acute
renal insufficiency
Viet Nam War Post-traumatic acute respiratory
insufficiency
Seventys 70s syndrome
1991 Multiple organ dysfunction syndrome
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Case report
Left leg open trauma
Day 2 Shortness of breath, Oliguria
Day 4 T 39.5 ??WBC (18109/L) ? R 35 /m,
cyanosis, PaO2lt60mmHg Urine lt100ml/d Creatinine
?? BUN ??
Respiratory failure
Renal failure
Day 6 Death
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Definition
Multiple Organ Dysfunction Syndrome
(MODS) is dysfunction of two or more organs
(initially uninvolved developing within a short
period of time.
two or more organs
initially
short period
uninvolved
Cor pulmonale?
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Causes
Multiple system organ failure. The role of
uncontrolled infection .
1980,115(2)136-140.

• They studied multiple parameters in
• 553 consecutive emergency surgical
• patients.
• MSOF is primarily due to infection.
• MSOF is the most common fatal
• expression of uncontrolled infection.

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Why did anti-biotic strategies fail in some of
the patients with MODS?
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MODS
Infective diseases
Non-infective diseases
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MODS
Infective diseases
Non-infective diseases
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Bacterial translocation
The viable bacili locomote from the
gastrointestinal tract to the other organs.
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Causes for the translocation
Intestinal flora imbalance Intestinal mucosal
ischemia Immune dysfunction
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Infective diseases
Non-infective diseases
MODS
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Mechanism

• Uncontrolled inflammatory response

• Microcirculatory hypo-perfusion

• Ischemia/reperfusion injury

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Causes
Uncontrolled inflammatory response
MODS
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Inflammation
Inflammatory cells Inflammatory cytokines
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Anti-inflammatory reaction IL-10, IL-4,
TGF-ß IL-1ra ,Lipoxin Cell elimination
Pro-inflammatory reaction TNF-a, IL-1, IL-6,
IFN TXA2, PAF Cell activation
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MODS is the failure of the balance
Uncontrolled inflammatory response
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Systemic Inflammatory Response Syndrome (SIRS)
?Definition?

• An uncontrolled inflammation process
• Pro-inflammatory signals exceed its normal
• domain or degree
• Result in end-organ damage and multi-system
• failure.

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Infection/ injury
Inflammatory stimulator
Local inflammatory cell activated (M?,PMN,VEC,)
Pro-inflammatory mediators released
Systemic inflammatory cell activated (M?,PMN,VEC,
)
Tissue injury
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?SIRS Clinical manifestations?

• Body temperature above 38? or less than 36?.
• Heart rate gt90 beat/min.
• Respiration rate gt20/min or PaCO2 lt32 mmHg.
• WBC gt12,000/mm3 or lt4000 cells/mm3, or gt10
• immature cells.

above 38?
gt20/min
gt12,000/mm3
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Case review
Left leg open trauma
SIRS
Renal failure
Respiratory failure
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Compensatory Anti-inflammatory Response Syndrome(
CARS)
?Definition?

• An uncontrolled anti-inflammation process
• Anti-inflammatory signals exceed its normal
• domain or degree
• Result in end-organ damage and multi-system
• failure.

Immune paralysis
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Infection/Injury
Uncontrolled inflammatory response
Controlled inflammatory response
SIRS
CARS
Infection/injury controlled
MODS
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Summary
Infection/Injury
Host response
Adequate
Inadequate
Death
Infection/injury controlled
Excessive
Uncontrolled inflammatory response
SIRS
CARS
MODS
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No great discovery was ever made without a bold
guess.
Isaac Newton
(1642-1727)
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