Multisystem Organ Dysfunction

Syndrome (MODS)
Renee Smith DNP, EdD(c), ACNP
CDU Faculty
MODS

Is a condition that occurs when two or

more organs or organ systems can’t
maintain homeostasis
Intervention is necessary to support &
maintain organ function
MODS

MODS is not an illness itself it is a

manifestation of another progressive
underlying condition
MODS Development

MODS develops when widespread

systemic inflammation a condition known
as SIRS (systemic inflammatory response
syndrome) overtaxes a patients
compensatory mechanisms
Infection, ischemia, trauma of any sort,
reperfusion injury, or multisystem injury
can trigger SIRS
SIRS Unchecked!

If allowed to progress SIRS can lead to

organ inflammation and MODS!
Mortality Rates

MODS is directly related to the number of

organ systems or organs affected
85% mortality when 3 organs involved
95% mortality when 4 organs involved
99% mortality when 5 organs involved
Classification of MODS

MODS can be primary or secondary

Classification of MODS

Primary: organ or organ system is due to a

direct injury, trauma or primary disorder
Usually involves the lungs, pneumonia,
aspiration, near drowning, pulmonary
embolism
Organ failure can be directly linked to the
direct injury
Classification of MODS

Primary (cont):
Typically ARDS develops & progresses
leading to encephalopathy & coagulopathy
from hepatic involvement
As syndrome continues other organ
systems are affected
Classification of MODS
Secondary: organ or organ system failure is due to
sepsis
 Typically the infection source isn’t associated
with the lungs
 Most common infection sources include
intrabdominal sepsis, extensive blood loss,
pancreatitis or major vascular injury
 ARDS develops sooner in secondary &
progressive involvement of other organs and
systems occurs more rapidly
Assessment Findings
Typically a acutely ill patient with signs &
symptoms associated with SIRS
Early findings:
 Fever usually > 101F
 Tachycardia
 Narrowed pulse pressure
 Tachypnea
 Decreased PCWP, PAP, CVP,
 Increased CO r/t tachycardia
SIRS Progression
As SIRS progresses, findings reflect impaired
perfusion of the tissues & organs
 Decreasing LOC
 Respiratory depression
 Diminished bowel sounds
 Jaundice
 Oliguria or anuria
 PAP increases due to pulmonary edema
 PAWP increases & CO increases with
development of heart failure
Organ Dysfunction
Organ dysfunction is determined by specific
criteria
 Pulmonary organ dysfunction is identified by
development of ARDS, requiring PEEP >10 &
FIO2<50%
 Hepatic dysfunction, jaundice with serum
bilirubin levels of 8-10mg/dl
 Renal dysfunction, Oliguria of <500ml/day,
Increasing serum Crt
 Hematologic dysfunction, development of DIC
Treatment MODS

Treatment focuses on supporting respiratory

& circulatory function by using:
ICU admission
Mechanical ventilation
Supplemental oxygen
Hemodynamic monitoring
Fluid infusion to expand & maintain
intravascular volume
Monitoring Required

Renal function is monitored, including

hourly uop rates
Serial renal labs for trends indicating acute
renal failure
Dialysis may be necessary
Treatment: Drug Therapies

Antimicrobial agents to treat underlying

infection
Vasopressors: dopamine, norepinephrine
Isotonic crystolloids: NS, LR to expand the
intravascular volume
Colloids: albumin, to expand volume
without fluid overload issue
Experimental Drugs

Some experimental drugs are being used:

Antitumor necrosis factor
Endotoxin
Anti interleukin 1 antibodies
Evidence supporting the effectiveness of
these agents is not available.
Nursing Care

Care is primarily supportive care

Close extensive monitoring, ICU level
Emotional support given high mortality
rates, organ involvement dependent