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PubMed2005

A 12-year prospective study of postinjury multiple organ failure: has anything changed?

HYPOTHESIS: The incidence and severity of postinjury multiple organ failure (MOF) has decreased over the last decade. DESIGN: A prospective 12-year inception cohort study ending December 31, 2003. SETTING: Regional academic level I trauma center. PATIENTS: One thousand three hundred forty-four trauma patients at risk for postinjury MOF. Inclusion criteria were aged older than 15 years, admission to the trauma intensive care unit, an Injury Severity Score higher than 15, and survival for more than 48 hours after injury. Isolated head injuries were excluded from this study. Previously identified risk factors for postinjury MOF were age, Injury Severity Score, and receiving a blood transfusion within 12 hours of injury. MAIN OUTCOME MEASURES: Multiple organ failure was defined by a Denver MOF score of 4 or more for longer than 48 hours after injury. Multiple organ failure severity was defined by the maximum daily MOF score and the number of MOF free days within the first 28 postinjury days. RESULTS: Multiple organ failure was diagnosed in 339 (25%) of 1244 patients. The mean age and Injury Severity Scores increased and the use of blood transfusion during resuscitation decreased over the 12-year study period. After adjusting for age, injury severity, and amount of blood transfused during resuscitation, there was a decreased incidence of MOF over the study period. Of the patients who developed MOF, there was a decrease in disease severity and duration as measured by the maximum daily MOF score and the MOF free days. Although the overall mortality rate remained constant, the MOF-specific mortality decreased. CONCLUSIONS: The incidence, severity, and attendant mortality of postinjury MOF decreased over the last 12 years despite an increased MOF risk. Improvements in MOF outcomes can be attributed to improvements in trauma and critical care and are associated with decreased use of blood transfusion during resuscitation.

Adult↗
PubMed1998

Plasma nitrite and nitrate concentrations and multiple organ failure in pediatric sepsis.

OBJECTIVE: To determine whether plasma nitrite and nitrate concentrations are associated with the development of sepsis-induced multiple organ failure. DESIGN: Prospective study. SETTING: University children's hospital. PATIENTS: Fifty-three consecutive children meeting criteria for sepsis and not receiving exogenous sources of nitric oxide. INTERVENTIONS: Plasma nitrite and nitrate concentrations were measured, and the number of organs failing was scored using an organ failure index on the first 3 days of sepsis. MEASUREMENTS AND MAIN RESULTS: Children with three or more organs failing on day 3 of sepsis had higher plasma nitrite and nitrate concentrations than children who had resolution of failure of three or more organs by day 3 of sepsis (days 2 and 3) and children who never had three organs failing in the first 3 days of sepsis (days 1, 2, and 3). Children who developed sequential pulmonary/hepatic/renal organ failure had significantly higher plasma nitrite and nitrate concentrations (days 1, 2, and 3). Nonsurvivors had significantly higher plasma nitrite and nitrate concentrations (days 2 and 3) than survivors. Plasma nitrite and nitrate concentrations on day 1 predicted the development of persistent failure of three of more organs and sequential multiple organ failure but not mortality. CONCLUSION: Increased plasma nitrite and nitrate concentrations are associated with the development of multiple organ failure in pediatric sepsis.

Adolescent↗
PubMed1991

[The multiple organ failure syndrome (MOFS) and septic states].

The multiple organic failure syndrome (MOFS or MOF) is the result of a hyperergic and chaotic activation of the unspecific immune (inflammatory) system. It may be elicited, either as a consequence of hypodynamic shock phenomena with initial tissular lesions caused by a diseased peripheral vascular bed, characteristic of states of shock, or as the result of an inflammatory aseptic or septic focus occurring in the process of transformation of tissular territories diseased under the action of various factors (traumatic, thermic, immune etc.). The local inflammatory process sets in motion a series of elements of the immune apparatus, such as: polynuclear neutrophilic leucocytes, macrophages, complement, which lead, when they begin to exert an hyperergic action, to the cascade activation of these elements also outside the focus of lesion, generating disseminated lesions at the level of organs and systems of organs. The lesions have an aleatory character and affect variously organs and territories, leading finally to insufficiency phenomena with clinical expression: renal failure, pulmonary failure, encephalopathy, shock digestive tract, intravascular disseminated coagulation, state of shock initially hyperdynamic and afterwards hypodynamic, metabolic disturbances etc. The specific manifestations, the symptomatology, the therapy and the prognosis of the syndrome are described.

Humans↗
PubMed1983

Exploratory laparotomy for potential abdominal sepsis in patients with multiple-organ failure.

We studied 29 patients with multiple-organ failure (MOF) who underwent exploratory laparotomy because of suspected intra-abdominal sepsis. The purpose was to identify predictors of continuing abdominal sepsis and to assess outcome of operation in these severely ill patients. The strongest predictor of continuing intra-abdominal sepsis was development of unexplained single-organ failure, which occurred in 17 patients. Physical findings were not a totally reliable indicator of abdominal sepsis since only 15 of 29 patients had acute abdominal findings. The main clue to sepsis in patients without acute abdominal findings was worsening organ failure. Fifteen of 29 patients died of continuing MOF. Only one patient older than 50 years survived. We suggest that earlier operation is indicated in certain patients with organ failure. Particularly aggressive operative therapy seems justified in young patients with unexplained single-organ failure or worsening MOF.

Abdomen, Acute↗
PubMed1986

Multiple-organ failure and sepsis without bacteria. An experimental model.

Multiple-organ failure is generally attributed to bacterial infection, although a correlation with positive blood cultures is not consistently found. Consequently, we studied the effects of a local nonbacterial inflammatory stimulus on distant organ functions and metabolism. Wistar rats were inoculated intraperitoneally with zymosan. Heart and ventilatory rates, oxygen consumption, and body temperature were measured. Survivors were killed at day 12 for blood analysis, weighing of organs, and microscopy. Intraperitoneal zymosan resulted in an early hyperdynamic "septic" response with a 35% mortality. After a few days, oxygen consumption decreased, serum lactate levels increased, and the function of multiple organs deteriorated, while blood cultures remained sterile. The experiment was repeated in germ-free rats with similar results but a lower mortality. We concluded that a severe inflammatory response in itself is capable of inducing multiple-organ failure with "sepsis."

Animals↗
PubMed1990

Multiple organ failure--a role for plasma exchange?

Two patients with multiple organ failure, septicaemia and a deteriorating clinical course were treated by plasma exchange in addition to standard supportive measures. Dramatic improvements were seen in cardio-respiratory (patient 1), neurological and renal parameters (patient 2) which were attributable to the exchanges. Plasma exchange might be of value as adjunctive therapy where overwhelming septicaemia occurs with multiple organ failure.

Adult↗
PubMed1996

Monitoring of blood volume during haemodialysis treatment of acute renal and multiple organ failures.

The assessment of the level of hydration in the intravascular fluid compartment in acute renal failure (ARF) and multiple organ failure (MOF) is of an utmost importance. However, the data on monitoring of blood volume in these diseases and especially during haemodialysis treatment are lacking. This article summarizing the experience of monitoring of blood volume in chronic haemodialysis suggests that the application of such monitoring will contribute to better results in haemodialysis treatment of ARF and MOF.

Acute Kidney Injury↗
PubMed1987

Postoperative multiple organ failure.

Cellular damage is the pathophysiologic basis for the postoperative multiple organ failure syndrome. This damage may be caused by pre- and intraoperative shock. Postoperative organ failure is manifested when cellular repair does not occur. Three factors may contribute to this progression to multiple organ failure: inadequate resuscitation, malnutrition, and sepsis.

Hemodynamics↗
PubMed2002

The injured child is resistant to multiple organ failure: a different inflammatory response?

BACKGROUND: Although postinjury multiple organ failure (MOF) is a well-described phenomenon in adults, the incidence of this syndrome in children is unknown. The purpose of this study was to describe the incidence, course, and severity of pediatric postinjury MOF. We hypothesized that the incidence and severity of postinjury MOF in children would be less when compared with adults. METHODS: Patients were retrospectively identified from the trauma registry of a regional pediatric trauma center and an adult Level I trauma center with pediatric commitment for a 3-year period. All trauma patients less than 16 years old who survived for longer than 24 hours and had an Injury Severity Score > 15 were eligible. An accepted MOF score was used. Categorical variables were compared by chi2 and continuous variables by t test. A value of p< 0.05 was considered statistically significant. RESULTS: Of 534 patients identified, 334 (63%) were admitted for evaluation of isolated head injury and excluded from further analysis. The rate of postinjury MOF in children was found to be only 3%, with a low (17%) mortality when compared with historical adult data (50%). CONCLUSION: The incidence of postinjury MOF in the child is less than in the adult, given equivalent injury severity. These observations solidify the contention that postinjury MOF is rare in children, and is less severe when it occurs. Delineating the mechanism(s) whereby children are protected from postinjury MOF may provide insight into the development of strategies to prevent MOF in other age groups as well as various disease states.

Adolescent↗
PubMedDate not supplied

[Severe sepsis and multiple organ failure in surgical patients in intensive care unit of oncological profile].

Forty-seven cases with grave sepsis and multiple organ failure in patients operated on for malignant tumors of different localizations and treated in intensive care wards of Cancer Research Center in 1996 are analyzed. In 35 patients sepsis developed due to pyoseptic complications of surgery and led to multiple organ failure, in 12 sepsis complicated multiple organ failure of other origin. Four or five organ systems were involved in 2/3 of patients with "primary" sepsis and in almost all patients with "secondary" sepsis. Sepsis and multiple organ failure in surgical cancer patients are believed to differ much from those in general surgical patients, which is explained by the scope of intervention, a tendency to decrease the number of indications for surgery, and by profound impairment of immunity and metabolism.

Humans↗
PubMed2000

Metabolic encephalopathy in critically ill patients suffering from septic or nonseptic multiple organ failure.

OBJECTIVE: Evaluation of changes in the peak latencies of sensory evoked potentials in different patient groups, to evaluate differences in metabolic encephalopathy of critically ill patients with multiple organ failure as a result of septic or nonseptic conditions. DESIGN: Prospective cohort study. SETTING: Intensive care units of the university hospital, Vienna. PATIENTS: Patients (n = 103) treated on an intensive care unit because of multiple organ failure with additional metabolic encephalopathy. Multiple organ failure was induced by sepsis (group A; n = 56), surgery (group B; n = 29), or both (group C; n = 18). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Metabolic encephalopathy was determined by measuring median nerve-stimulated short-latency and long-latency sensory evoked potentials. No differences in the peak latencies of the sensory evoked potentials were detected among the groups. Septic patients had a N70 peak latency of 131+/-21 msecs, nonseptic postsurgical patients of 132+/-17 msecs, and septic postsurgical patients of 134+/-17 msecs. The cervicomedullary N13 to cortical N20 conduction times were 6.4+/-1 msec, 6.4+/-1.4 msecs, and 6.8+/-1.2 msecs, respectively. All measured peak latencies were significantly prolonged compared with peak latencies of healthy controls. The severity of illness assessed by the Acute Physiology and Chronic Health Evaluation III score was not different between the three groups. An increase of the delay of N70 peak latencies was significantly correlated with the severity of illness (r2 = .15; p < .00005). CONCLUSION: There was no difference in sensory evoked potential measurements detectable among septic patients with multiple organ failure, nonseptic postsurgical patients with multiple organ failure, and septic postsurgical patients with multiple organ failure. The N70 peak latency was significantly correlated with the severity of illness but not with the presence or absence of sepsis. In postsurgical patients with multiple organ failure and superimposed sepsis, the N70 peak latencies were not further prolonged compared with postsurgical patients without sepsis.

Adult↗
PubMed2001

[Multiple organ failure. Mechanisms, clinical manifestations and treatment strategies].

Multiple organ failure (MOV) still represents the leading medical and economical problem in the care of the critically ill surgical patient. Although the incidence of MOF has tended to decrease over the last several years reflecting improved surgical and supportive therapy in the ICU, prognosis still remains serious when MOF develops. MOF seems to reflect a dysregulation of host-defence systems, such as innate immune, coagulation and complement systems, which are likely to reflect a more general dysregulation of cellular and subcellular functions, such as signal transduction and stress gene expression. Besides complexity and redundancy of the mediator systems involved, their beneficial local reparative as opposed to detrimental systemic effects may have contributed to the disappointing results of anti-mediator strategies in the treatment of MOF and sepsis. Although treatment of the underlying disease remains the cornerstone of the care of the critically ill patient to prevent MOF, recent results indicating a decreased mortality in severely septic patients receiving activated protein C as a supportive treatment suggest that modulation of the mediator cascades of sepsis and MOF remains a generally promising therapeutic strategy.

Humans↗
PubMed2006

[Significance of multiple organ failure for the prognosis of surgical intensive care patients].

BACKGROUND: The association of multiple organ failure and acute prognosis is an established fact in intensive care medicine. However, it is unclear whether the number of failing organs is an independent determinant of acute mortality, and whether there are additional effects on long-term outcome. METHODS: We performed a retrospective, observational cohort study using prospectively collected data from March 1993, through February 2005. Three different cohorts were analysed: patients with a short-term intensive care unit (ICU) stay (group I, ICU length of stay > 4 days), with a long-term ICU stay (group II, ICU length of stay > 28 days), and all patients requiring renal replacement therapy during ICU stay (group III). Organ failure was defined according to a modified Goris score. An independent effect of the number of failing organs on patient prognosis was evaluated after adjusting for more than 15 covariables. Acute prognosis was analysed in group I, whereas long-term prognosis was studied in groups II and III. RESULTS: The maximum number of failing organs was an independent determinant of acute prognosis in patients of group I, and of long-term prognosis in groups II and III. CONCLUSION: The effect of multiple organ failure on long-term prognosis emphasizes the importance of this variable for patient outcome. Therefore, multiple organ failure must be part of all therapeutic concepts in critical care. Within those, preventive measures are definitively preferable to keep the number of failing organs as small as possible.

APACHE↗
PubMed1993

[Translocation and multiple organ failure].

A review of bacterial translocation and multiple organ failure (MOF) is presented. Splanchnic ischaemia plays a central role in the development of MOF, but the exact mechanism of translocation is unclear. The concentration of endotoxins and bacteria in the gut is high. The critically ill patient is often treated with antibiotics with a broad antibacterial spectrum and overgrowth of Gram negative bacteria will take place in the gut favouring the translocation phenomenon. The regime of selective gut decontamination is discussed. Regional and systemic oxygen kinetics together with metabolic markers are important in detecting splanchnic ischaemia. Hepatic vein catheterisation and gastric mucosa pHi are discussed. The regional inflammation in the gut is often initiated by endotoxins, which stimulate the cytokines IL-1, IL-6 and TNF. Another important factor that can accentuate inflammation of the gut is reperfusion injury. A proposal for treatment of splanchnic ischaemia and translocation is discussed i.e.: optimizing central haemodynamic parameters, optimizing the regional microcirculation, treatment with antibodies to endotoxins, gut decontamination and early enteral nutrition. When splanchnic hypoperfusion is detected it cannot be ignored. It may be possible to correct the hypoperfusion with early gastrointestinal resuscitation and to thereby reduce the duration and mortality of MOF. The above mentioned suggestions are all very demanding of resources, but have to be considered in gut directed therapy.

Anti-Bacterial Agents↗
PubMed1995

Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma.

OBJECTIVE: To evaluate the posttraumatic course of several inflammatory mediators or markers (complement components C3, C3a, terminal complement complex, thromboxane B2, C-reactive protein, elastase, and neopterin) in relation to the development of multiple organ failure and mortality. DESIGN: Prospective study of a selected patient group. SETTING: Surgical intensive care units in three European trauma hospitals. PATIENTS: Patients (n = 56) with severe blunt trauma (Injury Severity Score of > or = 33). INTERVENTIONS: Arterial blood samples were sequentially obtained. MEASUREMENTS AND MAIN RESULTS: Nonsurvivors (n = 8) had significantly higher circulating C3a and elastase concentrations on the first postinjury day, compared with survivors (n = 48). No differences between these groups were found for terminal complement complex, thromboxane B2, C-reactive protein, and the neopterin/creatinine ratio. Five patients died before day 5. Eighteen patients developed multiple organ failure, which was diagnosed from day 5 onward, leaving 33 patients without multiple organ failure. The patients with subsequent multiple organ failure showed significantly higher mean circulating concentrations of C3a (914 +/- 190 [SEM] ng/mL), terminal complement complex (57 +/- 17 U/mL), and thromboxane B2 (275 +/- 37 pg/mL) at the first postinjury day than the patients without multiple organ failure (566 +/- 110 ng/mL, 27 +/- 2 U/mL, and 169 +/- 14 pg/mL, respectively). In patients with multiple organ failure, elastase concentrations were significantly higher on days 2, 3, 4, and 5 postinjury. Neopterin/creatinine ratios, on the other hand, were significantly higher in patients with multiple organ failure when the multiple organ failure had already become established (on days 8 and 10). CONCLUSION: In multiple trauma patients, excessive triggering of the inflammatory cascade-as expressed by complement activation and stimulation of neutrophils producing elastase--plays an important and early role in the development of multiple organ failure.

Adolescent↗
PubMed1996

[A pathological study of goat multiple organ failure model].

We succeeded in replication a standardized goat model of multiple organ failure (MOF). In the experimentation, the animals were monitored and supported with facilities pertaining to a human intensive care unit, with constant infusion of LPS into portal vein following trauma and hemorrhagic shock. The main organs of MOF goats were observated by the light microscopy and electronmicroscopy, including the lungs, hearts, livers, kidneys, intestines and spleens. The results showed that there were some areas of spotty and mass necrosis in the organ parenchyma with inflammatory cell infiltration. Our studies suggested that once the clinical multiple organ failure, severe pathological changs occur in organs.

Animals↗