Multiple Organ Dysfunction Syndrome (MODS) Jianzhong Sheng MD, PhD Department of Pathophysiology School of Medicine Zhejiang University

Definition Dysfunction or failure of multiple organ or system happened simultaneously or sequentially due to various etiological factors.

Etiology Infection: Gram positive/negative bacteria, fungal, Virus Shock :hemorrhage, etc. Allergy Burns Trauma Severe acute pancreatitis

Classification of MODS Immediate Type (Primary)：Dysfunction are happened simultaneously in two or more organs due to primary disease. Delayed type (Secondary）：Dysfunction happened in a organ, other organs sequentially happened dysfunction or failure. Accumulation type：Dysfunction leaded by chronic disease.

Attention Immediate Type Accumulation type Delayed type Not related to SIRS Coup injury with chemical or physical factors No time interval from disease ARDS+ARF or ARDS+ARF+DIC+LF Accumulation type Accumulation Irreversible Delayed type Not the direct outcome from injury Relating to SIRS（systemic inflammatory response syndrome） Time interval existed from primary disease ARDS: acute respiratory distress syndrome ARF: acute renal failure LF: liver failure

Mechanism

Vascular permeability↑＋ PMN chemotaxis Injury factors Inflammatory mediators priming SIRS leading to MODS Vascular permeability↑＋ PMN chemotaxis Adhensive molecules PMN Mono / Macrophage elastase PLA2 oxygen free radicals TNF IL－8 IL－1 IL－6 Endothelium PAF DIC Tissue injury Liver： acute phase Remote organ injury PMN PAF, platelet activating factor polymorphonucleocyte

Common Manifestations of MODS Organ Symptoms Heart Acute heart failure Peripheral circulation Shock Lung ALI /ARDS Kidney ARF Gastro-intestine Stress ulcer/enteroparalysis Liver Acute hepatic failure Brain CNS failure Coagulation DIC

Diagnosis of Criteria

Organ/ system dysfunction and failure

GLASGOW SCORE

Treatments of MODS

Combined therapy Correction of ischemia: fluid resuscitation, mechanical ventilation Prevention of infection：drainage, antibiotics Interruption of pathological reaction：hemofiltration Stabilization of internal environment：water, electrolyte, acid-base imbalance Regulation of immunity：cellular and humor

Support of organ function Ventilator Artificial kidney Artificial liver Protection of enteral mucosa Drugs of protection of heart

Thanks!