Multiple System Organ Failure

Chapter 81 Multiple System Organ Failure



Mark J. Seamon, MD, Abhijit S. Pathak, MD




Cases Considered



1. Multiple system organ failure (MSOF) in a 58-year-old male with acute pancreatitis

2. MSOF in a 22-year-old male after suffering multiple gunshot wounds, requiring massive blood transfusion

3. MSOF in a 75-year-old woman with pneumonia and sepsis following an esophagectomy



Speaking Intelligently



Multisystem Organ Failure


When asked to assess a patient who is likely to have multisystem organ failure (MSOF), I specifically look to uncover any infectious or inflammatory source that may have set off the process. This requires a detailed hx and a complete physical examination. Given the patient’s clinical situation, a detailed hx may be difficult to obtain. Accordingly, I make it a point to review all hospital records from this and previous admissions, and I talk to family members who might be informed about recent events. I carefully assess all of the patient’s comorbidities, including hx of tobacco (COPD) and alcohol (cirrhosis) use, which may play an important role in ultimate outcome.



Clinical Thinking


Questions I ask myself when caring for a critically ill patient:


• Is this patient in MSOF?

• If so, what was the underlying cause of the MSOF?

• What diagnostic modalities will determine the cause of MSOF?

• How will I treat the underlying cause of MSOF?

• How will I support the organ systems affected by MSOF?



Medical Knowledge



Definition



image Organ dysfunction/failure—altered organ function that requires intervention in an acutely ill patient.
image Usually results from a pathological amplification of inflammatory cytokines.

image Infection or systemic inflammation is frequent trigger of this immune response.

image MSOF—results when more than one organ system fails.
image Infection or sepsis may produce MSOF, but MSOF often occurs without clinically evident infection.

image In general, mortality correlates directly with increasing number of failed organs.

image MSOF is the leading cause of late postsurgical or postinjury deaths.


Etiology



image The “two-hit model”
image Initial insult primes the immune system and inflammatory response.

image A second insult amplifies the inflammatory response to produce MSOF.


Signs and Symptoms



image Vary with organ systems affected; for example,
image Neurologic: delirium, coma

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  3. Whipple Procedure (Pancreaticoduodenectomy)
  4. Nutrition Support in the ICU

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Mar 20, 2017 | Posted by in GENERAL SURGERY | Comments Off on Multiple System Organ Failure

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