Perioperative multiple organ dysfunction syndrome

K. Wood, L. Connery, D. B. Coursin

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1 Scopus citations

Abstract

Multiple organ dysfunction syndrome is the major cause of protracted ICU patient care, morbidity, and mortality. Improved techniques to define the entity, identify the development of MODS, and establish methods to prevent or treat established MODS are needed to enhance survival. Anesthesiologists must provide meticulous attention to detail, careful planning of perioperative management of these patients, and well-coordinated transport of MODS patients. The anesthetic management of these patients requires a complete knowledge of the patient's status and efforts to maintain fluid balance, gas exchange, and temperature homeostasis. A host of innovative therapies have been tried in the past 10 to 20 years. Only a few have withstood the test of time. Many proposed remedies have been single-shot or short-term therapies directed toward a specific mediator or time point in the evolution of a critical illness. It may be too simplistic to hope that a single monoclonal antibody, receptor agonist/antagonist, antioxidant, anti-inflammatory, cellular modulator, or the like will prevent, stop, or reverse excessive systemic inflammation or organ damage. Therefore, a multimodal approach may be needed. Identification of the progression to irreversible end-organ dysfunction is needed to enhance development of effective therapies. Systemic inflammatory response syndrome/MODS will remain major causes of morbidity and mortality as our population ages, as an increasing number of patients are immunosuppressed, and as resources continue to be stretched. The backbone of successful care of those at risk for developing SIRS/MODS will continue to be prevention. Perioperative physicians need to be aware of techniques to better identify at-risk patients; intervene preemptively; explore alternative therapeutic options if a surgical procedure has excessive risk; and anticipate delayed sequelae secondary to intraoperative events. Multimodal therapy will hopefully be forthcoming. Unfortunately, the development of such approaches may be exorbitantly expensive. This calls for well-designed and executed multicenter, prospective studies. An example is the evolving data generated by the SUPPORT and ARDS networks. The application of molecular biologic techniques to diagnose and treat the most critically ill should be on the horizon. This may allow more specific targeting of therapy. Improved imaging and minimally invasive or percutaneous procedures continue to grow. Finally, the use of nutriceuticals, immune manipulation, hemofiltration or diafiltataion, organ support systems (ie, artificial or temporary liver), site-specific drugs, and more selective sedatives and analgesics are under development.

Original languageEnglish (US)
Pages (from-to)27-43
Number of pages17
JournalSeminars in Anesthesia
Volume18
Issue number1
DOIs
StatePublished - 1999

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

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