Skip to main content

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICMSOFT,volume 38))

Abstract

Multiple organ failure (MOF) is the leading cause of death in intensive care units. First described some 30 years ago [1, 2], MOF was originally thought to be due to the presence of uncontrolled infection. More recently, we have begun to realize that while infection can, and often does, play an important role, it is only one of many factors involved. Indeed, MOF is not an isolated disease process, but rather a clinical syndrome with different patients demonstrating different combinations and severity of organ dysfunction; as such, MOF is difficult to define and to describe. In this chapter, we will briefly describe recent advances in characterizing and assessing MOF in the intensive care unit (ICU) population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Skillman JJ, Bushnell LS, Goldman H, Silen W (1969) Respiratory failure, hypotension, sepsis, and jaundice. A clinical syndrome associated with lethal hemorrhage from acute stress ulceration of the stomach. Am J Surg 117: 523–530

    Article  PubMed  CAS  Google Scholar 

  2. Tilney NL, Bailey GL, Morgan AP (1973) Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg 178: 117–122

    Article  PubMed  CAS  Google Scholar 

  3. Heard SO, Fink MP (1991) Multiple organ failure syndrome — Part I: Epidemiology, prognosis, and pathophysiology. Intensive Care Med 6: 279–294

    Google Scholar 

  4. De Backer D, Vincent JL (1995) VO2-DO2 relationship are altered in some critically ill patients. Semin Respir Crit Care Med 16: 394–402

    Article  Google Scholar 

  5. Haupt MT, Gilbert EM, Carlson RW (1985) Fluid loading increases oxygen consumption in septic patients with lactic acidosis. Am Rev Respir Dis 131: 912–916

    PubMed  CAS  Google Scholar 

  6. Gilbert EM, Haupt MT, Mandanas RY, Huaringa AJ, Carlson RW (1986) The effect of fluid loading, blood transfusion and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Rev Respir Dis 134: 873–878

    PubMed  CAS  Google Scholar 

  7. Groeneveld ABJ, Rester ADM, Nauta JJP (1987) Relation of arterial blood lactate to oxygen delivery and hemodynamic variables in human shock states. Circ Shock 22: 35–53

    PubMed  CAS  Google Scholar 

  8. Vincent JL, Roman A, De Backer D, Kahn RJ (1990) Oxygen uptake/supply dependency: Effects of short-term dobutamine infusion. Am Rev Respir Dis 142: 2–8

    Article  PubMed  CAS  Google Scholar 

  9. Fenwick JC, Dodek PM, Ronco JJ, Phang PT, Wiggs B, Russell JA (1990) Increased concentrations of plasma lactate predict pathological dependence of oxygen consumption on oxygen delivery in patients with adult respiratory distress syndrome. J Crit Care 5: 81–87

    Article  Google Scholar 

  10. Bakker J, Vincent JL (1991) The oxygen supply dependency phenomenon is associated with increased blood lactate levels. J Crit Care 6: 152–159

    Article  Google Scholar 

  11. De Backer D, Moraine JJ, Berre J, Kahn RJ, Vincent JL (1994) Effects of dobutamine on oxygen consumption in septic patients: direct vs indirect determinations. Am Rev Respir Crit Care Med 150: 95–100

    Article  Google Scholar 

  12. Shoemaker WC, Appel PL, Kram HB (1988) Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Crit Care Med 16: 1117–1120

    Article  PubMed  CAS  Google Scholar 

  13. Rixen D, Siegel JH (2000) Metabolic correlates of oxygen debt predict posttrauma early acute respiratory distress syndrome and the related cytokine response. J Trauma 49: 392–403

    Article  PubMed  CAS  Google Scholar 

  14. De Backer D, Creteur J, Vincent JL (2000) Dobutamine improves microvascular blood flow in patients with septic shock. Crit Care Med 28: A200 (Abst)

    Google Scholar 

  15. De Backer D, Preiser JC, Creteur J, Vincent JL (2001) Alterations in microvascular blood flow in septic patients can be reversed by acetylcholine. Am J Respir Crit Care Med 163: A137 (Abst)

    Google Scholar 

  16. Bernard GR, Vincent JL, Laterre PF, et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709

    Article  PubMed  CAS  Google Scholar 

  17. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186

    Article  PubMed  CAS  Google Scholar 

  18. Boyd O, Grounds M, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270: 2699–2707

    Article  PubMed  CAS  Google Scholar 

  19. Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333: 1025–1032

    Article  PubMed  CAS  Google Scholar 

  20. Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330: 1717–1722

    Article  PubMed  CAS  Google Scholar 

  21. De Backer D, Creteur J, Zhang H, Norrenberg M, Vincent JL (1997) Lactate production by the lungs in acute lung injury. Am J Respir Crit Care Med 156: 1099–1104

    Article  PubMed  Google Scholar 

  22. De Backer D, Creteur J, Silva E, Vincent JL (2001) The hepatosplanchnic region is not a common source of lactate in patients with severe sepsis. Crit Care Med 29:256–261

    Article  PubMed  Google Scholar 

  23. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ-system failure. Ann Surg 202: 685–693

    Article  PubMed  CAS  Google Scholar 

  24. Hebert PC, Drummond AJ, Singer J, Bernard GR, Russell JA (1993) A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome. Chest 104: 230–235

    Article  PubMed  CAS  Google Scholar 

  25. Zimmerman JE, Knaus WA, Sun X, Wagner DP (1996) Severity stratification and outcome prediction for multisystem organ failure and dysfunction. World J Surg 20:401–405

    Article  PubMed  CAS  Google Scholar 

  26. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ (1995) Multiple organ dysfunction score: A reliable descriptor of a complex clinical outcome. Crit Care Med 23:1638–1652

    Article  PubMed  CAS  Google Scholar 

  27. Vincent JL, Moreno R, Takala J, Willatts S, de Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22: 707–710

    Article  PubMed  CAS  Google Scholar 

  28. Vincent JL, de Mendonça A, Cantraine F, et al (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: Results of a multicentric, prospective study. Crit Care Med 26: 1793–1800

    Article  PubMed  CAS  Google Scholar 

  29. Russell JA, Singer J, Bernard GR, et al (2000) Changing pattern of organ dysfunction in early human sepsis is related to mortality. Crit Care Med 28: 3405–3411

    Article  PubMed  CAS  Google Scholar 

  30. Moreno R, Vincent JL, Matos A, et al (1999) The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Intensive Care Med 25: 686–696

    Article  PubMed  CAS  Google Scholar 

  31. Bone RC, Balk RA, Cerra FB, et al (1992) Definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101: 1644–1655

    Article  PubMed  CAS  Google Scholar 

  32. Salvo I, de Cian W, Musicco M, et al (1995) The Italian SEPSIS study: Preliminary results on the incedence and evolution of SIRS, sepsis, severe sepsis and septic shock. Intensive Care Med 21:S244–S249

    Article  PubMed  Google Scholar 

  33. Rangel Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273: 117–123

    Article  PubMed  CAS  Google Scholar 

  34. Knaus WA, Sun X, Nystrom PO, Wagner DP (1992) Evaluation of definitions for sepsis. Chest 101:1656–1662

    Article  PubMed  CAS  Google Scholar 

  35. Fox-Dewhurst R, Alberts MK, Kajikawa O, et al (1997) Pulmonary and systemic inflammatory responses in rabbits with gram-negative pneumonia. Am J Respir Crit Care Med 155: 2030–2040

    Article  PubMed  CAS  Google Scholar 

  36. Napolitano LM, Ferrer T, McCarter RJ, Scalea TM (2000) Systemic inflammatory response syndrome score at admission independently predicts mortality and length of stay in trauma patients. J Trauma 49: 647–652

    Article  PubMed  CAS  Google Scholar 

  37. Muckart DJ, Bhagwanjee S (1997) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 25: 1789–1795

    Article  PubMed  CAS  Google Scholar 

  38. Bossink AW, Groeneveld AB, Koffeman GI, Becker A (2001) Prediction of shock in febrile medical patients with a clinical infection. Crit Care Med 29: 25–31

    Article  PubMed  CAS  Google Scholar 

  39. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL (1996) Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 171: 221–226

    Article  PubMed  CAS  Google Scholar 

  40. Dugas MA, Proulx F, de Jaeger A, Lacroix J, Lambert M (2000) Markers of tissue hypoperfusion in pediatric septic shock. Intensive Care Med 26: 75–83

    Article  PubMed  CAS  Google Scholar 

  41. Poeze M, Takala J, Grève JW, Ramsay G (2000) Pre-operative tonometry is predictive for mortality and morbidity in high-risk surgical patients. Intensive Care Med 26: 1272–1281

    Article  PubMed  CAS  Google Scholar 

  42. Gomersall CD, Joynt GM, Freebairn RC, Hung V, Buckley TA, Oh TE (2000) Resuscitation of critically ill patients based on the results of gastric tonometry: a prospective, randomized, controlled trial. Crit Care Med 28: 607–614

    Article  PubMed  CAS  Google Scholar 

  43. Lobo S, Lobo F, Peres Bota D, Ferreira F, Vincent JL (2000) Admission CRP levels are correlated with mortality and organ failure. Crit Care Med 28: A192 (Abst)

    Article  Google Scholar 

  44. Chen CC, Wang SS, Chao Y, et al (1992) C-reactive protein and lactate dehydrogenase isoenzymes in the assessment of the prognosis of acute pancreatitis. J Gastroenterol Hepatol 7: 363–366

    Article  PubMed  CAS  Google Scholar 

  45. Ugarte H, Silva E, Mercan D, de Mendonça A, Vincent JL (1999) Procalcitonin as a marker of infection in the intensive care unit. Crit Care Med 27: 498–504

    Article  PubMed  CAS  Google Scholar 

  46. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J (1999) Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care (Lond) 3: 45–50

    Article  Google Scholar 

  47. Waydhas C, Nast-Kolb D, Jochum M, et al (1992) Inflammatory mediators, infection, sepsis and multiple organ failure after severe trauma. Arch Surg 127: 460–467

    Article  PubMed  CAS  Google Scholar 

  48. Roumen RM, Redl H, Schlag G, et al (1995) Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma. Crit Care Med 23: 474–480

    Article  PubMed  CAS  Google Scholar 

  49. Marecaux G, Pinsky MR, Dupont E, Kahn RJ, Vincent JL (1996) Blood lactate levels are better prognostic indicators than TNF and IL-6 levels in patients with septic shock. Intensive Care Med 22: 404–408

    Article  PubMed  CAS  Google Scholar 

  50. Moss M, Bucher B, Moore FA, Moore EE, Parsons PE (1996) The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults. JAMA 275: 50–54

    Article  PubMed  CAS  Google Scholar 

  51. Jurkovich GJ, Rivara FP, Gurney JG, et al (1993) The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA 270: 51–56

    Article  PubMed  CAS  Google Scholar 

  52. Moss M, Guidot DM, Steinberg KP, et al (2000) Diabetic patients have a decreased incidence of acute respiratory distress syndrome. Crit Care Med 28: 2187–2192

    Article  PubMed  CAS  Google Scholar 

  53. Schroder J, Kahlke V, Staubach KH, Zabel P, Stuber F (1998) Gender differences in human sepsis. Arch Surg 133: 1200–1205

    Article  PubMed  CAS  Google Scholar 

  54. Mizushima Y, Wang P, Jarrar D, Cioffi WG, Bland KI, Chaudry IH (2000) Estradiol administration after trauma-hemorrhage improves cardiovascular and hepatocellular functions in male animals. Ann Surg 232: 673–679

    Article  PubMed  CAS  Google Scholar 

  55. Mira JP, Cariou A, Grall F, et al (1999) Association of TNF2, a TNF-alpha promoter polymorphism, with septic shock susceptibility and mortality: a multicenter study. JAMA 282: 561–568

    Article  PubMed  CAS  Google Scholar 

  56. Stuber F, Petersen M, Bokelmann F, Schade U (1996) A genomic polymorphism within the tumor necrosis factor locus influences plasma tumor necrosis factor-alpha concentrations and outcome of patients with severe sepsis. Crit Care Med 24: 381–384

    Article  PubMed  CAS  Google Scholar 

  57. Tang GJ, Huang SL, Yien HW, et al (2000) Tumor necrosis factor gene polymorphism and septic shock in surgical infection. Crit Care Med 28: 2733–2736

    Article  PubMed  CAS  Google Scholar 

  58. Appoloni O, Dupont E, Andrien M, Duchateau J, Vincent JL (2001) Association of TNF2, a TNFα promoter polymorphism, with plasma TNFα levels and mortality in septic shock. Am J Med 110:486–488

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2002 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Vincent, JL., Lopes Ferreira, F. (2002). Multiple Organ Failure: Clinical Syndrome. In: Evans, T.W., Fink, M.P. (eds) Mechanisms of Organ Dysfunction in Critical Illness. Update in Intensive Care and Emergency Medicine, vol 38. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56107-8_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-56107-8_28

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-42692-9

  • Online ISBN: 978-3-642-56107-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics