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Multiple Organ Dysfunction Syndrome

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Surgery

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Abstract

Multiple organ dysfunction syndrome (MODS) is a common cause of death among critically ill surgical patients. Although a substantial population of those who die subsequent to critical surgical illness have functional failure of multiple organs, the precise cause of death is more commonly withdrawal of specific supports. Put differently, advances in surgical critical care during the past several decades have afforded recovery to some patients and sustained compensation of organ dysfunction to others. The synchronous application of multiple systems support interrupts the dying process for nearly all patients. Some recover promptly, others recover slowly, while many others appear not to benefit from physiological support. It is this latter group, often sustained for days and weeks in the intensive care unit, who die as supports are declined or formally withdrawn. This chapter focuses on the problem of MODS rather than providing evidence-based recommendations for therapy. This format is used because there are no interventions that have been prospectively demonstrated to reverse this deadly process.

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References

  1. Nielsen D, Sellgren J, Ricksten SE. Quality of life after cardiac surgery complicated by multiple organ failure. Crit Care Med 1997; 25: 2552–2557.

    Google Scholar 

  2. Barie PS, Hydo U. Influence of multiple organ dysfunction syndrome on duration of critical illness and hospitalization. Arch Surg 1996; 131: 1318–1323.

    Article  PubMed  CAS  Google Scholar 

  3. Vincent JL. Prevention and therapy of multiple organ failure. World J Surg 1996; 20: 465–470.

    Article  PubMed  CAS  Google Scholar 

  4. Barie PS, Hydo LJ, Fischer E. Development of multiple organ dysfunction syndrome in critically ill patients with perforated viscus. Predictive value of APACHE severity scoring. Arch Surg 1996; 131: 37–43.

    Article  PubMed  CAS  Google Scholar 

  5. Bernard C. Leçons sur les Phénomènes de la Vie Communs aux Animaux et aux Végétaux. Paris: Ballière, 1878.

    Google Scholar 

  6. Cannon WB. The Wisdom of the Body. New York: Norton, 1939.

    Google Scholar 

  7. Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340: 409–417.

    Article  PubMed  CAS  Google Scholar 

  8. Natanson C, Hoffman WD, Suffredini AF, et al. Selected treatment strategies for septic shock based on proposed mechanisms of pathogenesis. Ann Intern Med 1994; 120: 771–783.

    Article  PubMed  CAS  Google Scholar 

  9. Bickell WH, Wall MJ, Pepe PE, et al. Immediate versus delayed resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994; 331: 1105–1110.

    Article  PubMed  CAS  Google Scholar 

  10. Graf H, Leach W, Arieff AI. Evidence for a detrimental effect of bicarbonate therapy in hypoxie lactic acidosis. Science 1985; 227: 754–756.

    Article  PubMed  CAS  Google Scholar 

  11. Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med 1992; 20 (1): 80–93.

    Article  PubMed  CAS  Google Scholar 

  12. Human albumin administration in critically ill patients. Cochrane Injuries Group albumin reviewers. BMJ 1998; 317: 235–240.

    Article  Google Scholar 

  13. Cryer HG, Leong K, McArthur DL, et al. Multiple organ failure: by the time you predict it, it’s already there. J Trauma 1999; 46: 597–604.

    Article  PubMed  CAS  Google Scholar 

  14. Cannon WB. Physiological regulation of normal states: some tentative postulates concerning biological homeostatics. In: Charles Richet A, ses Amis, ses Collègues, ses Élèves, 22 Mai 1926. Auguste Pettit, ed. Paris: Les Éditions Médicales, 1926: 91–93.

    Google Scholar 

  15. Buchman TG. Physiologic stability and physiologic state. J Trauma 1996; 41: 599–605.

    Article  PubMed  CAS  Google Scholar 

  16. Winchell RJ, Hoyt DB. Analysis of heart-rate variability: a noninvasive predictor of death and poor outcome in patients with severe head injury. J Trauma 1997; 43: 927–933.

    Article  PubMed  CAS  Google Scholar 

  17. Winchell RJ, Hoyt DB. Spectral analysis of heart rate variability in the ICU: a measure of autonomic function. J Surg Res 1996; 63: 11–16.

    Article  PubMed  CAS  Google Scholar 

  18. Schäfer C, Rosenblum MG, Kurths J, Abel HH. Heartbeat synchronized with ventilation. Nature (Lond) 1998, 392: 239–240.

    Article  Google Scholar 

  19. Godin PJ, Fleisher LA, Eidsath A, et al. Experimental human endotoxemia increases cardiac regularity: results from a prospective, randomized, crossover trial. Crit Care Med 1996; 24: 1117–1124.

    Article  PubMed  CAS  Google Scholar 

  20. Goldstein B, Toweill D, Lai S, Sonnenthal K, Kimberly B. Uncoupling of the autonomic and cardiovascular systems in acute brain injury. Am J Physiol 1998; 275: R1287 - R1292.

    PubMed  CAS  Google Scholar 

  21. Godin PJ, Buchman TG. Uncoupling of biological oscillators: a complementary hypothesis concerning the pathogenesis of multiple organ dysfunction syndrome. Crit Care Med 1996, 24: 1107–1116.

    Article  PubMed  CAS  Google Scholar 

  22. Goldwyn RM, Friedman HP, Siegel JH. Iteration and interaction in computer data bank analysis: a case study in the physiologic classification and assessment of the critically ill. Comput Biomed Res 1971; 4: 607.

    Article  PubMed  CAS  Google Scholar 

  23. Regel G, Grotz M, Weltner T, Sturm JA, Tscherne H. Pattern of organ failure following severe trauma. World J Surg 1996, 20: 422–429.

    Article  PubMed  CAS  Google Scholar 

  24. Malcolm DS, Zaloga GP, Holaday JW. Calcium administration increases the mortality of endotoxic shock in rats. Crit Care Med 1989; 17: 900–903.

    Article  PubMed  CAS  Google Scholar 

  25. Nast-Kolb D, Waydhas C, Gippner-Steppert C, et al. Indicators of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries. J Trauma 1997; 446: 446–454.

    Article  Google Scholar 

  26. Zeni F, Freeman B, Natanson C. Anti-inflammatory therapies to treat sepsis and septic shock: a reassessment. Crit Care Med 1997; 25: 1095–1100.

    Article  PubMed  CAS  Google Scholar 

  27. Moore FA, Moore EE, Poggotti R, et al. Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma. J Trauma 1991; 31: 629–636.

    Article  PubMed  CAS  Google Scholar 

  28. Cerra FB, Maddaus MA, Dunn DL, et al. Selective gut decontamination reduces nosocomial infections and length of stay, but not mortality or organ failure, in surgical intensive care unit patients. Arch Surg 1992; 127: 163–169.

    Article  PubMed  CAS  Google Scholar 

  29. Moore FA, Moore EE, Kudsk KA, et al. Clinical benefits of an immune-enhancing diet for early postinjury enteral feeding. J Trauma 1994; 37: 607–615.

    Article  PubMed  CAS  Google Scholar 

  30. Upperman JS, Deitch EA, Guo W, Lu Q, Xu D. Post-hemorrhagic shock mesenteric lymph is cytotoxic to endothelial cells and activates neutrophils. Shock 1998; 10: 407–414.

    Article  PubMed  CAS  Google Scholar 

  31. Christou NV, Meakins JL, Gordon J, et al. The delayed hypersensitivity response and host resistance in surgical patients 20 years later. Ann Surg 1995; 222: 534–548.

    PubMed  CAS  Google Scholar 

  32. Lederer JA, Rodrick ML, Mannick JA. The effects of injury on the adaptive immune response. Shock 1999; 11: 153–159.

    Article  PubMed  CAS  Google Scholar 

  33. Hotchkiss RS, Swanson PE, Freeman BD, et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 1999; 27: 1230–1238.

    Article  PubMed  CAS  Google Scholar 

  34. Hotchkiss RS, Swanson PE, Knudson CM, et al. Overexpression of Bc1–2 in transgenic mice decreases apoptosis and improves survival in sepsis. J Immunol 1999; 162: 4148–4156.

    PubMed  CAS  Google Scholar 

  35. Hotchkiss RS, Tinsley KW, Swanson PE, et al. Prevention of lymphocyte cell death in sepsis improves survival rate in mice. Proc Natl Acad Sci USA 1999; 96: 14541–14546.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Timothy G. Buchman
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Editor information

Editors and Affiliations

  1. University of California, San Francisco, USA

    Jeffrey A. Norton MD (Professor and Vice-Chairman of Surgery, Chief) (Professor and Vice-Chairman of Surgery, Chief)

  2. Surgical Service, San Francisco VA Medical Center, San Francisco, California, USA

    Jeffrey A. Norton MD (Professor and Vice-Chairman of Surgery, Chief) (Professor and Vice-Chairman of Surgery, Chief)

  3. Division of General Surgery, Duke University Medical Center, Durham, North Carolina, USA

    R. Randal Bollinger MD, PhD (Professor of Surgery, Professor of Immunology, Chief) (Professor of Surgery, Professor of Immunology, Chief)

  4. Division of Surgical Oncology, University of Michigan, Comprehensive Cancer Center, Ann Arbor, Michigan, USA

    Alfred E. Chang MD (Chief, Hugh Cabot Professor of Surgery) (Chief, Hugh Cabot Professor of Surgery)

  5. Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA

    Stephen F. Lowry MD (Professor and Chairman) (Professor and Chairman)

  6. Division of General Surgery, University of California, San Francisco, San Francisco, California, USA

    Sean J. Mulvihill MD (Professor of Surgery, Chief) (Professor of Surgery, Chief)

  7. Karmanos Cancer Institute, Wayne State University, Harper Hospital, Detroit, Michigan, USA

    Harvey I. Pass MD (Professor of Surgery and Oncology, Chief of Thoracic Oncology) (Professor of Surgery and Oncology, Chief of Thoracic Oncology)

  8. Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri, USA

    Robert W. Thompson MD (Associate Professor of Surgery) (Associate Professor of Surgery)

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© 2001 Springer Science+Business Media New York

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Buchman, T.G. (2001). Multiple Organ Dysfunction Syndrome. In: Norton, J.A., et al. Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-57282-1_19

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  • DOI: https://doi.org/10.1007/978-3-642-57282-1_19

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-63239-6

  • Online ISBN: 978-3-642-57282-1

  • eBook Packages: Springer Book Archive

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