多系统器官衰竭英文课件

Multiple Organ Dysfunction Syndrome (MODS)多器官功能障碍综合征,Lecturer Dr. Xianmin Bu 卜献民,Definition,Multiple organ dysfunction syndrome MODS: Multiple organs or systems dysfunction occur simultaneously or progressively following severe infection, severe trauma and shock. The affected organs/systems may be respiratory, cardiovascular, renal, hepatic, gastrointestinal, hematological, endocrine, and central nervous system. MODS is an important reason for the death of severe patient.,The Evolution of MODS,In World War I, injured soldiers died in the battlefield of profound cardiac failure. This was presumed to be caused by wound toxins, but clinical interventions were largely undefined.In World War II and to a greater extent in the Korean War, the loss of blood volume was recognized to be the primary cause of traumatic shock. battlefield casualties were resuscitated with blood and plasma until blood pressure returned to normal. As a result, more soldiers survived their initial insult; however, the severely injured often succumbed to oliguric renal failure.,The Evolution of MODS,1960s - ARDS was described in Vietnam “Shock Lung”.1973 - Tilney described multiple organ failure (MOF) or Multi System Organ Failure (MSOF). They concluded that MOF syndrome was the result of a combination of preexisting disease and hemorrhagic shock.1980s - began to realize concept of sepsis. MOF was considered as a fatal expression of uncontrolled infection.1990s systemic hyperinflammation became the focus, now referred to as the systemic inflammation response syndrome (SIRS).,The Evolution of MODS,MODS replaces “Multi System Organ Failure” or MSOFMODS is a range of dysfunctional organs, not just failureAltered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention,MOF and MODS,Multiple organ failure (MOF):Progressive distant organ failure (initially uninvolved) following severe infectious or noninfectious insults (severe burn, multiple trauma, shock, acute pancreatitis)MOF is the finality of MODS,mechanism,basis diseases:Severe tissue injury or blood and fluid loss due to trauma, burn and major operationSevere infectionShockresuscitation of cardiac and respiratory arrestAcute haemorrhagic necrotic pancreatitis, colic intestine obstruction, rewarming of cold injuryMisapplication of infusion, drug, or respirator.Primary disease: coronary heart disease, liver cirrhosis, chronic nephrosis,mechanism,The mechanisms of MODS are enormously compiex and poorly understood.Systemic inflammatory response syndrome (SIRS) is the main reason of MODS.Definition: pathologic inflammatory response to injury or infectionDiagnostic criteria: any two or more of the following manifestations: 1.temp 38 or 90/min 3.respiratory rate 20/min or hyperventilation (PaCO2 12,000 cells/mm3,or 10%,mechanism,To every action there is always opposed an equal reaction: or, the mutual action of two bodies upon each other are always equal, and directed to contrary parts.-Sir Isaac Newton, 1687Compensatory anti-inflammatory response syndrome (CARS)Imbalance of inflammatary response and anti-inflammatory response SIRS CARS, MODS occurs.,mechanism,Enterogenous infection ischemic injury Intestine mucosal barrier dysfunction Bacterial Translocation Enterogenous/entr infection release of inflammatory mediators MODs,Clinical feature and diagnosis,Two type: Primary: rapid, 24 hours after acute primary disease, two or more organs dysfunction. The occurrence of MODS is due to a direct injury or insult to an organ or system. As contusion of lung from trauma, coagulapathy induced by multiple blood transfusion, acute renal shut down from drugs. Secondary: tardy, after an initial organ dysfunction and a steady period, two or more organs dysfunction occurs secondarily. it is a consequence of the host response, which result in an inflammatory response in organ distant from the site of the initial insult.,Cardiovascular,Acute heart failuer:Tachycardia, arrhythmiaAbnormal ECGShock :BP, coldness of extremities, oliguria microcirculation abnormal,Respiratory,acute respiratory distress syndrome (ARDS):tachypnea, wheezing, cyanose, dependence upon oxygenation support and mechanical ventilationHyperventilation results in respiratory alkalosisSevere hypoxemia, abnormal respiratory function.,mechanical ventilation,Renal,Acute renal failure(ARF):Sudden decline of urine output (less than 400ml/24hour) despite adequate fluidsSpecific gravity of urine Nain urine and Crin blood,Gastrointestinal,Stress ulcer and intestinal paralysis:Haematemesis呕血 hematochezia 便血 abdominal distention weak bowel soundsgastroscope,Hepatic,Acute hepatic failure :Jaundice Mind abnormal hepatic encephalopathyAbnormal biochemical liver function tests : bilirubin lift,Neurological,Central Nervous System failure: Conscious disturbance reactive depression of pain and sound stimulation,Disseminated intravascular coagulation (DIC),Ecchymosis 淤斑 Haematemesis 呕血 Haemoptysis 咯血 platelet count, fibrinogen, thrombin time (PT), partial thrombin time (PTT),Early diagnosis,1.Acquaintance with the high risk factors of MODS.severe infection (sepsis), trauma, burn, acute severe pancreatitis, etcTachypnea, Tachycardia, low BP, mind abnormal, oliguria, etc.The diagnosis of infection is very important.,Early diagnosis,2. SIRS + organ dysfunction = MODSOrgan dysfunction caused by SIRS induced damage such that homeostasis cannot be maintained without supportive measures SIRS must be identified as soon as possible in order to institute immediate treatment to try and prevent progression to MODS,Early diagnosis,3. Multiple organ dysfunction occurs progres-sively, either the initial organ or a distant organ.One organ dysfunction occurs, the others should be detected in time.DIC: ARDS, ARF, GI hemorrhage and cerebral hemorrhageIn clinic, ARDS hepatic failure, ARF and GI failure.,Early diagnosis,4. Pay more attention to organ dysfunction than organ failure. That SIRS evolves into MODS is a dynamic process.The dysfunction may be partial or complete, reversible or irreversible,Early diagnosis,5. Dysfunction of heart, lung, brain and kidney has a clear clinical manifestation, while until severe stage, dysfunction of liver, GI and haematological system has not a clear clinical manifestation. Some special accessory examinations are essential.,Prophylaxis and treatment,Synthetic and Supportive TherapyHigh mortalityProphylaxis is more important.,Prophylaxis and treatment,1. Improve the quality of resuscitation, attach importance to circulation and respiratory. correct hypovolemia, restore tissue perfusion and oxygen transportation,Prophylaxis and treatment,2. Control infection is a important measure to prevent MODS.Drainage of infectious focus, clearance of necrotic tissuesLocalization of infection to alleviate toxemia.Antibiotics,Prophylaxis and treatment,3. To manage single organ dysfunction early and block the pathologic chain reaction.More organs failure high mortality4. Improve general conditions.5. Protect intestinal mucous barrier, prevent bacterial translocation.6. Immune regulation,acute renal failure(ARF)Defination Acute renal failure is a condition in which the glomerular filtration rate is abruptly reduced, causing a sudden retention of endogenous metabolites that are normally cleared by the kidneys. Commonly, ARF is characterized by sudden reduce of urinary output.,oliguria urine volume400ml/dayauria ur