Abstract
It has been recognized for several years that organ failure is the leading cause of death in surgical patients.1 It is believed that most cases of multiple organ dysfunction syndrome (MODS) are precipitated by infection, but it is also recognized that the outcome of organ dysfunction does not correlate well with the microbiology of MODS.2 The isolated organisms are often avirulent bacterial opportunists, colonizing and sometimes invading hosts who are susceptible owing to debility. Moreover, patients who die with MODS often have no demonstrable active infection on postmortem examination.3 Indeed, some cases of organ dysfunction have been associated with histologic evidence of multiorgan inflammation in the absence of infection.4 Therefore it is possible that MODS is precipitated by an insult that causes a massive inflammatory response (systemic inflammatory response syndrome, or SIRS) or a dysregulated balance of proinflammatory and compensatory antiinflammatory responses (CARS).5.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Carrico CJ, Meakins JL, Marshall JC, et al: Multiple-organ-failure syndrome, Arch Surg 1986; 121: 196–208.
Marshal JC, Christou NV, Horn R, Meakins JL: The microbiology of multiple organ failure: the proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg 1988; 123: 309–315.
Sinanan M, Maier RV, Carrico CJ: Laparotomy for intrabdominal sepsis in patients in an intensive care unit. Arch Surg 1984; 119: 652–658.
Goris RJ, te Boekhorst TP, Nuytinck JK, Gimbrere JS: Multipleorgan failure: generalized autodestructive inflammation? Arch Surg 1985; 120: 1109–1115.
Bone RC: Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med 1996; 125: 680–687.
Kollef MH, Sharpless L, Vlasnik J, et al: The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997; 112: 666–675.
Barie PS, Hydo LJ, Fischer E: Development of multiple organ dysfunction syndrome in critically ill patients with perforated viscus: predictive value of APAGHE severity scoring. Arch Surg 1996; 131: 37–43.
Moore FA, Sauaia A, Moore EE, et al: Postinjury multiple organ failure: a bimodal phenomenon. J Trauma 1996; 40: 501–510.
Lemaire LG, van Lanschot JJ, Stoutenbeek CP, et al: Bacterial translocation in multiple organ failure: cause of epiphenomenon still unproven? Br J Surg 1997; 84: 1340–1350.
Moore FA, Moore EE: Evolving concepts in the pathogenesis of postinjury multiple organ failure. Surg Glin North Am 1995; 75: 257–277.
Waydhas C, Nast-Kolb D, Trupka A, et al: Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. J Trauma 1996; 40: 624–630.
Yao YM, Redl H, Bahrami S, Schlag G: The inflammatory basis of trauma/shock-associated multiple organ failure. Inflamm Res 1998; 47: 201–210.
Kirkpatrick CJ, Bittinger F, Klein CL, et al: The role of the microcirculation in multiple organ dysfunction syndrome (MODS); a review and perspective. Virehows Arch 1996; 427: 461–76.
Petty TL: Acute respiratory distress syndrome (ARDS). Dis Mon 1990; 36: 1–58.
Hinchey EJ, Hreno A, Benoit PR, et al: The stress ulcer syndrome. Adv Surg 1970; 4: 325–392.
Tilney NL, Bailey GL, Morgan AP: Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg 1973; 78: 117–122.
Baue AE: Multiple, progressive, or sequential systems failure: a syndrome of the 1970s. Arch Surg 1975; 110: 779–781.
Fry DE, Pearlstein L, Fulton RL, Polk HG Jr.: Multiple system organ failure: the role of uncontrolled infection. Arch Surg 1980; 115: 136–140.
Craven DE, Daschner FD: Nosocomial pneumonia in the intubated patient: role of gastric colonization. Eur J Clin Microbiol Infect Dis 1989; 8: 40–50.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: Prognosis in acute organ-system failure. Ann Surg 1985; 202: 685–693.
Bone RC, Balk RA, Gerra FB, et al: Definitions for sepsis and organ failure and uidelines for the use of innovative therapies in sepsis: the ACCP/SCCM consensus conference committee: American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644–1655.
Bone RC, Balk R, Slotman G, et al: Adult respiratory distress syndrome: sequence and importance of development of multiple organ failure; the Prostaglandin E1 Study Group. Chest 1992; 101: 320–326.
Marshall JC, Cook DJ, Christou NV, et al: Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23: 1638–1652.
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.
Talmor M, Hydo L, Barie PS: Relationship of systemic inflammatory response syndrome (SIRS) to organ dysfunction, length of stay, and mortality in critical surgical illness: effect of intensive care unit resuscitation. Arch Surg 1999; 134: 81–87.
Barie PS, Hydo LJ: Influence of multiple organ dysfunction syndrome on duration of critical illness and hospitalization. Arch Surg 1996; 131: 1318–1325.
Schwartz DB, Bone RC, Balk RA, Szidon JP: Hepatic dysfunction in the adult respiratory distress syndrome. Chest 1989; 95: 871–875.
Vincent JL, de Mendonca A, Cantraine F, et al: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study; working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 1998; 26: 1793–1800.
Le Gall JR, Klar J, Lemeshow S, et al: The logistic organ dysfunction system: a new way to assess organ dysfunction in the intensive care unit; ICU Scoring Group. JAMA 1996; 276: 802–810.
Rogy MA, Oldenburg HS, Coyle S, et al: Correlation between Acute Physiology and Chronic Health Evaluation (APACHE) III score and immunological parameters in critically ill patients with sepsis. Br J Surg 1996; 83: 396–400.
Law MM, Cryer HG, Abraham E: Elevated levels of IGAM-1 correlate with the development of multiple organ failure in trauma patients. J Trauma 1994; 37: 100–110.
Roumen RM, Redl H, Schlag G, et al: Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma. Crit Care Med 1995; 23: 474–480.
Patel RT, Deen KI, Youngs D, et al: Interleukin 6 is a prognostic indicator of outcome in severe intra-abdominal sepsis. Br J Surg 1994; 81: 1306–1308.
Marano M, Fong Y, Moldawer L, et al: Serum cachectin/TNF in cricitally ill burn patients correlates with infection and mortality. Surg Gynecol Obstet 1990; 170: 32–38.
Calvano SE, Coyle SM, Barbosa KS, et al: Multivariate analysis of nine disease-associated variables for outcome prediction in patients with sepsis. Arch Surg 1998; 133: 1347–1350.
Neidhardt R, Keel M, Steckholzer U, et al: Relationship of interleukin-10 plasma levels to severity of injury and clinical outcome in injured patients. J Trauma 1997; 42: 863–870.
Simms HH, D’Amico R: Granulocyte colony-stimulating factor reverses septic shock-induced polymorphonuclear leukocyte dysfunction. Surgery 1994; 115: 85–93.
Cobb JP, Hotchkiss RS, Karl IE, Buchman TG: Mechanisms of cell injury and death. Br J Anaesth 1996; 77: 3–10.
Fanning NF, Kell MR, Shorten GD, et al: Circulating granulocyte macrophage colony stimulating factor in plasma of patients with the systemic inflammatory response syndrome delays neutrophil apoptosis through inhibition of spontaneous reactive species generation. Shock 1999; 11: 167–174.
Barie PS, Hydo L, Fischer E: A prospective comparison of two different multiple organ failure/dysfunction scoring systems for prediction of mortality in critical surgical illness. J Trauma 1994; 37: 660–666.
Bertleff MJ, Braining HA: How should multiple organ dysfunction syndrome be assessed? A review of the variations hi current scoring systems. Eur J Surg 1997; 163: 405–409.
Maynard ND, Bihari DJ, Dalton RN, et al: liver function and splanchnic ischemia in critically ill patients. Chest 1997; 111: 180–187.
Barie PS, Hydo LJ, Fischer E: Utility of illness severity scoring for prediction of prolonged surgical critical care. J Trauma 1996; 40: 513–519.
Buchman TG, Kubos KL, Seidler AJ, Siegforth MJ: A comparison of statistical and connectionist models for the prediction of chronicity in a surgical intensive care unit. Crit Care Med 1994; 22: 750–762.
Muckart DJ, Bhagwanjee S: 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 1997; 25: 1789–1795.
Vincent JL: Dear SIRS, I’m sorry to say that I don’t like you.. Crit Care Med 1997; 25: 372–374.
Pittet D, Rangel-Frausto S, Li N, et al: Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med 1995; 21: 302–309.
Jimenez MF, Watson RW, Parodo J, et al: Dysregulated expression of neutrophil apoptosis in the systemic inflammatory response syndrome. Arch Surg 1997; 132: 1263–1269.
Haga Y, Beppu T, Doi K, et al: Systemic inflammatory response syndrome and organ dysfunction following gastrointestinal surgery. Crit Care Med 1997; 25: 1994–2000.
Mangano DT, Hollenberg M, Fegert G, et al: Perioperative myocardial ischemia in patients undergoing noncardiac surgery. I. Incidence and severity during the 4 day perioperative period: the Study of Perioperative Ischemia (SPI) research group. J Am Coll Cardiol 1991; 17: 843–850.
Bush HL, Hydo LJ, Fischer E, et al: Hypothermia during elective abdominal aortic aneurysm repair: the high price of avoidable morbidity. J Vase Surg 1995; 21: 392–402.
Ungureanu-Longrois D, Balligand JL, Kelly RA, Smith TW: Myocardial contractile dysfunction in the systemic inflammatory response syndrome: role of a cytokine-inducible nitric oxide synthase in cardiac myocytes. J Mol Cell Cardiol 1995; 27: 155–167.
Barie PS: Advances in critical care monitoring. Arch Surg 1997; 132: 734–739.
Gutierrez G, Palis F, Doglio G, et al: Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 1992; 339: 195–199.
Ivatury RR, Simon RJ, Havriliak D, et al: Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma: a prospective, randomized study. J Trauma 1995; 39: 128–134.
Bishop MH, Shoemaker WC, Appel PL, et al: Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 1995; 38: 780–787.
Cryer HG, Richardson JD, Longmire-Cook S, et al: Oxygen delivery in patients with ARDS who undergo surgery: correlation with multiple-system organ failure. Arch Surg 1989; 124: 1378–1385.
Moore FA, Haenel JB, Moore EES et al: Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple oigan failure. J Trauma 1992; 33: 1–9.
Danteker DR, Foresman B, Gutierrez G: Oxygen supply and utilization relationships: a reevaluation. Am Rev Respir Dis 1991; 143: 675–679.
Stratton HH, Feustel PJ, Newell JC: Regression of calculated variables in the presence of shared measurement error. J Appl Physiol 1987; 62: 2083–2093.
Gattinoni L, Brazzi L, Pelosi P, et al: A trial of goal-oriented hemodynamic therapy in critically ill patients: SvO2 Collaborative Group. N Engl J Med 1995; 333: 1025–1032.
Alia I, Esteban A, Gordo F, et al: A randomized and controlled trial of the effect of treatment aimed at maximizing oxygen delivery in patients with severe sepsis or septic shock. Chest 1999; 115: 453–461.
Martin C, Papazian L, Perrin G, et al: Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 1993; 103: 1826–1831.
Goncalves JG Jr, Hydo LJ, Barie PS: Factors influencing outcome of prolonged norepinephrine therapy for shock in critical surgical illness. Shock 1998; 10: 231–236.
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.
Nauwynck M, Huyghens L: Neurological complications in critically ill patients; septic encephalopathy, critical illness polyneuropathy. Acta Clin Belg 1998; 53: 92–97.
Sharif SF, Hariri RJ, Chang VA, et al: Human astrocyte production of tumour necrosis factor-α, interleukin-1β and interleukin-6 following exposure to Kpopolysaecharide endotoxin. Neurol Res 1993; 15: 109–112.
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.
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.
Godin PJ, Fleisher LA, Eidsath A, et al: Experimental human endotoxemia increases cardiac regularity: results from a prospective, randomized, crossover trial. Grit Care Med 1996; 24: 1117–1124.
Godin PJ, Buchman TG: Uncoupling of biological oscillators: a complementary hypothesis concerning the pathogenesis of multiple organ dysfunction syndrome. Grit Care Med 1996; 24: 1107–1116.
Leijten FS, Harinek-de Weerd JE, Poortvliet DC, de Weerd AW: The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA 1995; 274: 1221–1225.
Mangano DT, Layug EL, Wallace A, Tateo I: Effect of atenolol on mortality and cariovascular morbidity after noncardiac surgery: multicenter study of Perioperative Ischemia Research Group. N Engl J Med 1996; 335: 1713–1720.
Ginsberg JS, Wells PS, Kearon G, et al: Sensitivity and specificity of a rapid whole-blood assay for D-dimer in the diagnosis of pulmonary embolism. Ann Intern Med 1998; 129: 1006–1011.
Kollef MH, Eisenberg PR, Shannon W: A rapid assay for the detection of circulating D-dimer is associated with clinical outcomes among critically ill patients. Crit Care Med 1998; 26: 1054–1060.
Wallace JL: lipid mediators of inflammation in gastric ulcer. Am J Physiol 1990; 258: G1–G11.
Marrone GC, Silen W: Pathogenesis, diagnosis and treatment of acute gastric mucosal lesions. Clin Gastroenterol 1984; 13: 635–650.
Reines HD: Do we need stress ulcer prophylajris? Crit Care Med 1990; 18: 344.
Cook DJ, Fuller HD, Guyatt GH, et al: Risk factors for gastrointestinal bleeding in critically ill patients: Canadian Critical Care Trials Group. N Engl J Med 1994; 330: 377–381.
Driks MR, Craven DE, Celli BR, et al: Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers: the role of gastric colonization. N Engl J Med 1987; 317: 1376–1382.
Cook DJ, Reeve BK, Guyatt GH, et al: Stress ulcer prophylaxis in critically ill patients: resolving discordant meta-analyses. JAMA 1996; 275: 308–314.
Barie PS, Fischer E, Eachempati SR: Acute acalculous cholecystitis. Gurr Opin Crit Care 1999; 5: 144–150.
Wang P, Chaudry IH: Mechanism of hepatocellular dysfunction during hyperdynamic sepsis. Am J Physiol 1996; 270: R927–R938.
Schiodt FV, Ott P, Bondesen S, et al: Reduced serum Gc-globulin concentrations in patients with fulminant hepatic failure: association with multiple organ failure. Crit Care Med 1997; 25: 1366–1370.
Garber BG, Hebert PC, Yelle JD, et al: Adult respiratory distress syndrome: a systematic overview of incidence and risk factors. Crit Care Med 1996; 24: 687–695.
Sessler CN, Bloomfield GL, Fowler AA: Current concepts of sepsis and acute lung injury. Clin Chest Med 1996; 17: 213–235.
Moss M, Goodman PL, Heining M, et al: Establishing the relative accuracy of three new definitions of the adult respiratory distress syndrome. Crit Care Med 1995; 23: 1629–1637.
Hudson LD, Milberg JA, Anardi D, et al: Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med 1995; 151: 293–302.
Milberg JA, Davis DR, Steinberg KP, et al: Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-1993. JAMA 1995; 273: 306–309.
Rangel-Frausto M, Pittet D, Costigan M, et al: The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study. JAMA 1995; 273: 117–123.
Perl TM, Dvorak L, Hwang T, et al: Long-term survival and function after suspected gram-negative sepsis. JAMA 1995; 274: 338–345.
Fisher CJ, Dhainaut JA, Opal SM, et al: Recombinant human interleukin-1 receptor antagonist in the treatment of patients with sepsis syndrome: results from a randomized, double-blind, placebo-controlled trial. JAMA 1994; 271: 1836–1843.
Moss M, Goodman PL, Heinig M, et al: Establishing the relative accuracy of three new definitions of the adult respiratory distress syndrome. Crit Care Med 1995; 23: 1629–1637.
Hakim RM, Wingard RL, Parker RA: Effect of the dialysis membrane in the treatment of patients with acute renal failure. N Engl J Med 1994; 331: 1338–1342.
Schiffl H, Lang SM, Konig A, et al: Biocompatible membranes in acute renal failure: prospective case-controlled study. Lancet 1994; 344: 570–572.
Tani T, Hanasawa K, Endo Y, et al: Therapeutic apheresis for septic patients with organ dysfunction: hemoperfusion using a polymyxin B immohiMied column. Artif Organs 1998; 22: 1038–1044.
Koperna T, Yogi SE, Poschl GP, et al: Cytokine patterns in patients who undergo hemofiltration for treatment of multiple organ failure. World J Surg 1998; 22: 443–447.
Ferring M, Yincent JL: Is outcome from ARDS related to the severity of respiratory failure? Eur Respir J 1997; 10; 1297–1300.
Heyland DK, Cook DJ, Griffith L, et al: The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999; 159: 1249–1256.
Baue AE, Durham R, Faist E: Systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS)s multiple organ failure (MOF): are we winning the battle? Shock 1998; 10: 79–89.
Zimmerman JE, Knaus WA, Wagner DP et al: A comparison of risks and outcomes for patients with organ system failure: 1982–1990. Crit Care Med 1996; 24: 1633–1641.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2000 Springer Science+Business Media New York
About this chapter
Cite this chapter
Barie, P.S., Hydo, L.J. (2000). Epidemiology, Risk Factors, and Outcome of Multiple Organ Dysfunction Syndrome in Surgical Patients. In: Baue, A.E., Faist, E., Fry, D.E. (eds) Multiple Organ Failure. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1222-5_6
Download citation
DOI: https://doi.org/10.1007/978-1-4612-1222-5_6
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4612-7049-2
Online ISBN: 978-1-4612-1222-5
eBook Packages: Springer Book Archive