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Considerations in Organ Failure

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Surgical Metabolism

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Abstract

Recent advances about multiple-organ failure have highlighted several aspects of its diagnosis and management. However, broad areas remain undiscovered. The classic differentiation into two hits has been challenged with the discovery of mixed gene responses and prolonged clinical outcomes, leading to a new proposed concept, the persistent inflammation-immunosuppression catabolism syndrome (PICS). The incidence ranges between 15 and 40 % and associated mortality is six- to eightfold higher than patients without organ dysfunction. Current scoring systems are valid but are not useful for prognosis, as all of them lack specificity and sensibility for selected populations. Single organ dysfunction criteria has been revisited and revised: Berlin ARDS criteria, AKIN classification, and gastrointestinal failure. Physiopathology research has specially focused on gene involvement, neural regulation, and mitochondrial damage as future targets for innovative therapies. A search for early biomarkers is underway with limited results, and traditional nutritional support guidelines have been challenged.

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Authors and Affiliations

  1. Head of the Department of Internal Medicine and Critical Care Unit, Hospital Quirón Sagrado Corazón, Rafael Salgado 1, 41013, Sevilla, Spain

    Carlos Ortiz-Leyba MD, PhD

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  1. Carlos Ortiz-Leyba MD, PhD
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Correspondence to Carlos Ortiz-Leyba MD, PhD .

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  1. Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA

    Kimberly A. Davis

  2. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Stanley H. Rosenbaum

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Ortiz-Leyba, C. (2014). Considerations in Organ Failure. In: Davis, K., Rosenbaum, S. (eds) Surgical Metabolism. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1121-9_13

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