Preliminary results of the autopsy of Robert Leszczyński, who died on April 1, indicate that his death was due to multi-organ failure – Przemysław Nowak, spokesman for the District Prosecutor’s Office in Warsaw, told Onet. What is multi-organ failure?
Multiple organ dysfunction syndrome (MODS) is the body’s reaction to a harmful factor, during which the failure of at least two vital organs or systems occurs simultaneously or sequentially. It may eventually be fatal.
MODS multi-organ dysfunction syndrome, formerly called multi-organ failure (e.g.: multiple organ failure (MOF) lub multi-system organ failure (Multisystem organ failure (MSO)) is a disease syndrome that was defined only after the creation of intensive care units (previously practically absent).
Multiple organ failure shows an unstable clinical picture, which is a consequence of dynamically changing organ function.
Etiology
MODS is formed as a result of the body’s response to harmful factors:
1. Infectious – infection with Gram positive / negative bacteria, fungal, viral
2. Non-infectious: transfusion reaction, shock, severe haemorrhage, allergy, burn, trauma, acute pancreatitis
The phases of the run
1. Primary MODS (2-3 days) – occurs as a result of direct organ damage
2. Secondary MODS (days-weeks) – occur as a result / consequence of sepsis or multi-organ trauma with shock; the cascade leading to MODS is shown in the diagram below. Organs or systems become dysfunctional or die sequentially.
Generalized Inflammatory Response Syndrome Ssystematic Iinflammatory Rsponse Syndrome – SIRS) + infection
An example of a local organ response after initiating tissue decomposition: pulmonary (respiratory) failure occurs after 72 hours, liver failure occurs after 5-7 days, gastrointestinal failure due to bleeding occurs after 10-15 days, renal failure occurs after 11-17 days.
Pathofizjologia
The mechanism that causes multi-organ failure is a complex process consisting of many stages during which the immune response is disturbed.
The body’s generalized immune response to infection or factors such as trauma or burns involves the simultaneous activation of a number of both pro-inflammatory and anti-inflammatory factors. During the above-mentioned pathologies, pro-inflammatory mediators are secreted, mainly TNF (tumor necrosis factor – cachectin) and interleukins (mainly IL-1 and IL-6). Additionally, due to the damage caused by the secreted endotoxins, the activity of the endothelium of the blood vessels changes. These two mechanisms, the immune response and altered activity of the endothelium of blood vessels, lead to the intensification of coagulation processes while inhibiting endogenous fibrinolysis (i.e. decomposition of the clot). As a consequence, there is an imbalance between the processes of thrombus formation and dissolution, which in turn leads to the formation of more clots and then their enlargement (a process called DIC – disseminated intravascular coagulation). These processes lead to reduced tissue perfusion, tissue necrosis and the development of multi-organ failure, which can ultimately result in death.
Studies conducted in recent years have shown that one of the most important markers of the degree of hemostasis disorders in the course of sepsis (sepsis) and in MODS is the reduced activity of protein C. Protein C is one of the proteins that inhibit the blood coagulation process. During sepsis, its activation is impaired.
Treatment of multi-organ failure
1. Combination therapy
· Treatment of oschemia: fluid replenishment, mechanical ventilation
Prevention of infection: antibiotic therapy, drainage (wound closure)
· Interruption of pathological reactions: haemofiltration
Stabilization of the internal environment of the organism: replenishing water, appropriate electrolytes, and balancing the acid-base balance
2. Supporting the functioning of organisms
Ventilation
Artificial kidney
Artificial liver
Protection of the inner mucous membranes
Protective drugs for the heart