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

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

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

4. 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.

5. 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

6. Mechanism

7. Vascular permeability↑＋ PMN chemotaxis
Injury
factors
Inflammatory mediators priming SIRS leading to MODS
Vascular permeability↑＋ PMN chemotaxis
Adhensive molecules
PMN
Mono / Macrophage
elastase PLA 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

8. 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

9. Diagnosis of Criteria

10. Organ/ system dysfunction and failure

11. GLASGOW SCORE

12. Treatments of MODS

13. 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

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

15. Thanks!