NURS 530 Discussion Multiple Organ Dysfunction Syndrome (MODS)

NURS 530 Discussion multiple organ dysfunction syndrome (MODS)

NURS 530 Discussion multiple organ dysfunction syndrome (MODS)

DQ1 Select one of the following discussion prompts to address:

1. Describe the pathophysiology, clinical manifestations, evaluation, and treatment of atopic dermatitis, impetigo contagiosum, tinea capitis, thrush, and molluscum contagiosum.
2. Describe the pathophysiology, clinical manifestations, evaluation, and treatment(s) for psoriasis, lichen planus, pemphigus, seborrheic keratosis, and actinic keratosis.
3. Describe the incubation periods, onset of prodromal symptoms, duration, and characteristics of rashes and other clinical symptoms of the following viral diseases: rubella (German measles), rubeola (measles), roseola (exanthema subitum), and varicella (chickenpox). List the CDC-recommended childhood vaccination schedule applicable.

DQ2 Select one of the following discussion prompts to address:

1. Describe multiple organ dysfunction syndrome (MODS) and summarize the pathophysiology, clinical manifestations, evaluation, and treatment.
2. Describe the characteristics of first-, second-, and third-degree burns and the rule of nines assessment tool to estimate burn percentages. Discuss the recommended strategies for initial and maintenance fluid replacement after a major burn injury.
3. Summarize the causes, clinical manifestations, evaluation, and treatment for cardiogenic, hypovolemic, neurogenic, anaphylactic, and septic shock.

MODS is generally initiated by illness, injury or infection, causing a state of immunodepression and hypometabolism (Nickson 2019).

Rather than a single event, MODS is considered a continuum where the extent of dysfunction can vary greatly from mild impairment to irreversible failure (Al-Khafaji 2020).

Organs most commonly affected by MODS include the heart, lungs, liver and kidneys (Gu et al. 2018).

It is associated with significant mortality and morbidity, estimated to affect around 15% of ICU patients and contributing to about 50% of deaths in ICU (Nickson 2019; Osterbur et al. 2014).

Causes of Multiple Organ Dysfunction Syndrome

MODS is induced by illness, injury or infection that triggers an unregulated systemic inflammatory response (known as systemic inflammatory response syndrome), resulting in tissue injury (Harper & Saeb-Parsy 2013; Rossaint & Zarbock 2015).

The most common trigger is sepsis, but other causes include:

• Major trauma;
• Major surgery;
• Burns;
• Pancreatitis;
• Shock;
• Aspiration syndromes;
• Blood transfusions;
• Autoimmune disease;
• Acute heart failure; and
• Poisons/toxins.

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(Nickson 2019; Wang et al. 2017; Harjola et al. 2017)

Risk Factors for Multiple Organ Dysfunction Syndrome

• An individual’s genetics may dictate the likelihood and severity of MODS following a trigger.
• A patient with premorbid organ dysfunction may be prone to further deterioration.
• Medications, therapies and ICU supports may contribute to organ injuries.
• A patient with an infection is at risk of MODS.

(Nickson 2019)

How to Assess for Multiple Organ Dysfunction Syndrome

• Undertake a systems approach assessment (head-to-toe assessment).
• Document and analyse data from the patient’s vital signs, taking into account any trends.
• A SOFA score can be used in line with other assessment tools.

(Nickson 2019)

Presentation and Symptoms of Multiple Organ Dysfunction Syndrome

In order to be diagnosed with MODS, the patient should be experiencing dysfunction of at least two organs (this may be mild or severe) in addition to systemic inflammatory response syndrome (Nickson 2019).

Organ dysfunction may present as:

• Acute kidney injury (AKI) and uraemic acidosis;
• Acute respiratory distress syndrome (ARDS);
• Cardiomyopathy;
• Encephalopathy;
• Gastrointestinal dysfunction;
• Hepatic dysfunction;
• Coagulopathy and bone marrow suppression; and
• Acute neurological dysfunction.

(Nickson 2019)

The patient may display some of the following symptoms depending on which organs are affected:

• An altered mental state;
• A decrease in renal perfusion (decrease in urine output);
• Respiratory deterioration;
• A decrease in cardiac function;
• Deranged metabolic status;
• A compromised fluid balance;
• Pale, clammy, peripherally cool skin and faint pedal pulses; and
• A decrease in cardiac output (e.g. low blood pressure, arrhythmia).

(Procter 2019; Rahman, Shad & Smith 2012)

Systemic inflammatory response syndrome may present as:

• Increased body temperature;
• Increased resting heart rate;
• Increased respiratory rate; and
• An increased amount of white blood cells.

(Washmuth 2017)

Treatment and Management of Multiple Organ Dysfunction Syndrome

MODS is difficult to treat, escalates quickly and is often fatal. Therefore, early detection is crucial in preventing its progression (Wang et al. 2017).

Positive patient outcomes rely on immediate recognition, ICU admission and invasive organ support (Gourd & Nikitas 2019). Management and treatment may include:

• Identifying and treating the underlying causes, comorbidities or complications;
• Fluid resuscitation to increase perfusion; and
• Support care and monitoring:
  • Multi-organ support;
  • Mechanical or non-invasive ventilation;
  • Maintaining fluid homeostasis; and
  • Renal replacement therapy.

(Nickson 2019; Chapalain 2019; Scala & Pisani 2018)

Preventing Multiple Organ Dysfunction Syndrome

As a complication of an illness, injury or infection, MODS is difficult to prevent. Early recognition improves patient outcomes – this is the only way to prevent damage.

It is important to monitor patients closely and administer appropriate therapies to facilitate organ function (Al-Khafaji 2020).

• Maintain an accurate fluid balance chart;
• Support the haemodynamic needs of the patient (identify low blood pressure, analyse trends, escalate to the medical team and treat early);
• Identify any potential triggers of MODS;
• Ensure regular blood tests are performed; and
• Decrease the risk of further organ damage if MODS is identified through early implementation of care.

M.O.D.S. stands for multiple organ dysfunction syndrome.

Information about the author
A clinical condition that owes its existence to the creation of the intensive care unit (ICU) is the most prevalent cause of death for patients hospitalized to a modern intensive care unit (ICU). MODS, also known as multi-organ failure, multiple systems organ failure, or by any of its more conspicuous forms, such as acute respiratory distress syndrome (ARDS) or disseminated intravascular coagulation (DIC), is as little understood as it is common. It’s even worth debating the word. Despite the fact that the condition was first classified as multiple organ failure, it is clear that in survivors, normal physiologic function of the failing organ systems can be recovered. As a result, the process is better described as multiple organ dysfunction. Although the disease affects numerous organs, it also affects physiologic systems that aren’t traditionally thought of as organs, such as the hematologic, immunological, and endocrine systems. Finally, despite the fact that it is classified as a syndrome, its clinical course and etiology are highly variable, and there is only a smattering of agreement on the organs whose dysfunction constitutes the syndrome, or the criteria that should be used to classify this dysfunction.

Multiple Organ Dysfunction Syndrome (MODS) is defined as the emergence of potentially reversible physiologic derangement involving two or more organ systems not implicated in the condition that resulted in ICU admission, and occurring after a potentially life-threatening physiologic insult.

The ICU’s raison d’être is organ system specific assistance, thus it’s not strange that the necessity for such support has become a model for explaining the clinical course of the critically sick patient. In the 1960s, it was initially seen that critically ill patients die as a result of a complicated series of physiologic derangements that emerge during resuscitation and care in the ICU, rather than as a result of the progression of the condition that provoked ICU admission. In 1975, Baue published a seminal editorial in which he commented on the striking similarity of post mortem findings in patients dying in an ICU and suggested that the unsolved problem in critical care was not the failure of a single system, but the failure of multiple interdependent organ systems at the same time. Following investigations stressed the importance of occult, uncontrolled infection in the development of MODS, however infection control did not always result in reversal of the physiologic derangements, and infection was not always evident in individuals with the syndrome.

Visit MODS: Clinical and pathologic description for more information.
In a critically ill patient, organ dysfunction can be defined as either the clinical intervention used to support the failing organ system (mechanical ventilation, hemodialysis, inotropic or vasopressor agents, parenteral nutrition, etc.) or the acute physiologic derangement that necessitated such support. The initial descriptions of the condition typically enumerated the number of malfunctioning systems while utilizing clinical intervention as a descriptor. Recently, other similar descriptive measures based on the mathematical quantification of organ dysfunction have been established. The respiratory, cardiovascular, renal, hepatic, neurologic, and hematologic systems are all used to describe MODS in each study. They differ slightly in terms of the criteria used to indicate cardiovascular dysfunction, as well as the timing and weighting of the variables used. Table I shows the Multiple Organ Dysfunction (MOD) score, which is a measure based only on physiologic data.