MODS#medical-surgical nursing

1. Presented by,
Ms. Gautami .S. Tirpude
S.Y.MSc Nursing
B.V.C.O.N,Pune

2. AIM: At the end of the seminar students will be
able to gain indepth knowledge regarding
multiple organ dysfunction syndrome.

3. 1. Define MODS
2. List down etiological factors of MODS.
3. Understand the classification of MODS.
4. Describe the pathoysiology of MODS.
5. Enlist Clinical manifestations and diagnostic tests are
to be performed for MODS.
6. List down complications of MODS.
7. Explain collaborative management
including nursing management.

4.  Multiple organ dysfunction syndrome (MODS), also
known as multiple organ failure (MOF), total organ
failure (TOF) or multisystem organ failure (MSOF).
 It is altered organ function in acutely ill patients that
requires medical intervention to support continued
organ function.

5.  It is another phase in the progression of shock states.
 MODS contributes to about 50% of ICU deaths
 Dysfunction of one organ system is associated with
20% mortality, and if more than four organs fail, the
mortality is at least 60% (Rossaint & Zarbock, 2015)

6.  Systemic Inflammatory Response Syndrome is a
generalized systemic inflammatory response to a
variety of insults, including infection, ischemia,
infarction, and injury.
 MODS results from SIRS and is the failure of several
interdependent organ systems.
 MODS is the major cause of death of patients in the
critical care units.

7.  MODS is the failure of two or more organ systems in
an acutely ill patient such that homeostasis cannot be
maintained without intervention.
 SIRS is a systemic inflammatory response to a variety
of insults including infection, ischemia, infarction, and
injury, it leads to disorders of microcirculation, organ
perfusion and finally secondary organ dysfunction.

9. SR.
No
System Time from ICU
admission to onset of
significant dysfunction
(days)
1. Respiratory 1-2
2. Hematologic 3
3. Central nervous 4
4. Cardiovascular 4
5. Hepatic 5-6
6. Renal 4-11
7. Gastrointestinal 10-14

13.  Patients with infection
 Shock episode associated with a rupture aneurysm, acute
pancreatitis, sepsis, burns or surgical operation.
 Patients >65 years of age because of there decreased organ
reserve and presence of co- morbidities.
 Severe trauma, multiple injury, massive blood loss,
hypovolemic shock and infection.

14.  Sepsis
 Major trauma
 Burns
 Pancreatitis
 Aspiration syndromes
 Extracorporeal
circulation (e.g. cardiac
bypass)
 Multiple blood
transfusion
 Ischaemia– reperfusion
injury
 Autoimmune disease
 Heat-induced illness
 Eclampsia
 Poisoning/toxicity

15.  Immediate type(primary): Dysfunction/Failure
occurring simultaneously in two or more organs due to
primary disease.
 Delayed type(secondary): Dysfunction occurred in
one organ other organs sequentially fail.
 Accumulation type: Dysfunction is cause by chronic
disease. It is irreversible

16. INFECTION
INFLAMMATO
RY
MEDIATORS
ENDOTHELIAL
DYSFUNCTION
VASODILATI
ON
HYPOTENSIO
N
MICROVASCULA
R PLUGGING
VASOCONSTRICTI
ON
EDEMA
MALDISTRIBUTION OF MICROVASCULAR BLOOD FLOW
ISCHEMIA
CELL DEATH ORGAN DYSFUNCTION

17.  Respiratory system
 Dyspnea
 Increased RR
 Alveolar edema
 Decrease in surfactant
 V/Q mismatch
 hypoxemia
 Pulmonary
hypertension
 Decrease compliance
 Neurologic system
 Mental status changes
 Seizures
 Confusion
 Hepatic encephalopathy
 GIT
 Mucosal ischemia
 Hypo perfusion
 GI bleeding
 Gut leakiness

18. CVS
 Myocardial depression
 Increased
HR/CO/SVR
 Decreased stroke
volume/MAP/EF
 Hypotension
 Vasodilation
Hematologic
 Increased bleeding time
& fibrin split products
 Decreased platelet &
clotting factor
Endocrine
 Hyperglycemia
 Increased ADH
production and ACTH

19. History
 community or nosocomial infection
 immunocompromised patient
 underlying diseases
 Some clues to a septic event include
◦ Fever or unexplained signs with malignancy
◦ Hypotension
◦ Oliguria or anuria
◦ Tachypnea or hyperpnea
◦ Hypothermia without obvious cause
 Bleeding

20.  Physical Examination
In all neutropenic patients and pelvic infection the
physical exam should include rectal, pelvic, and genital
examinations
◦ perirectal, and/or perineal abscesses
◦ pelvic inflammatory disease and/or abscesses, or prostatitis

21.  CBC
 basic metabolic profile
 procalcitonin (PCT)
 CRP
 Blood cultures
 Urinalysis and culture
 Cardiac enzymes
 Amylase, lipase
 Spinal fluid and
 Liver profiles
 Blood lactate

22. ◦ Prevention and treatment of infection
◦ Maintenance of tissue oxygenation
◦ Nutritional and metabolic support
◦ Appropriate support of individual failing
organs

23. 1.PREVENTION & TREATMENT OF INFECTION
 Aggressive infection control strategies
 Cultures
 Broad-spectrum antibiotic therapy
 Necessary therapy should be initiated once a specific
organism is identified.
 Aggressive pulmonary management, including early
ambulation.
 Strict asepsis

24. 2. MAINTENANCE OF TISSUE OXYGENATION
 Decrease oxygen demand & increase oxygen delivery
are essential.
 Sedation, mechanical ventilation, analgesia, and rest
decrease oxygen demand.
 Oxygen delivery may be optimized by maintaining
normal levels of haemoglobin ,
using individualized tidal volumes with PEEP.

25. 3. NUTRITIONAL & METABOLIC NEEDS
 The goal of nutritional support is to preserve organ
function.
 Hypermetabolism in MODS can result in profound
weight loss, cachexia & further organ failure.
 Early & optimal nutrition
 Using enteral route.
 Parenteral nutrition should be intitiated.
 Glycemic control (<150mg/dl), using insulin infusions.

26. 4. SUPPORT OF FAILING ORGANS
Support of any failing organ is primary goal of therapy.
 Patient with ARDS - aggressive oxygen therapy &
mechanical ventilation.
 Renal failure – Dialysis
 Hemodynamic instability – continous renal
replacement therapy.

27.  Adult respiratory distress syndrome (ARDS)
 Disseminated Intravascular Coagulation (DIC)
 Acute Renal failure (ARF)
 Intestinal bleeding
 Liver failure
 Central Nervous System dysfunction
 Heart failure
 Death

28. 1.Ineffective airway clearance related to excessive secretion,
presence of an artificial airway, neuromuscular dysfunction.
2.Impaired gas exchange related to VQ mismatch,
intrapulmonary shunting, alveolar hypoventilation.
3. Decreased cardiac output related to alterations to preload,
afterload and contractility.
4. Imbalanced nutrition less than body requirements related to
less intake of exogenous nutrients and increased metabolic
demand.

29. 5. Ineffective tissue perfusion (cardiopulmonary, renal)
related to decreased myocardial oxygen supply than
demand.
6. Acute confusion related to sensory overload, sensory
deprivation and sleep pattern disturbance.

30. Aim: Supporting the patient and monitoring organ
perfusion until primary organ insults are halted.
1. Promoting Communication
 Encourage frequent and open communication about
treatment modalities.
 Information regarding goals of rehabilitation and
expectations for progress.

31.  Effective communication provides needed
encouragement during this phase of recovery.
2. Promoting Home, Community-Based, and
Transitional Care:
 Educating Patients About Self-Care
 Continuing and Transitional Care

32.  Year : 2017 | Volume : 146 | Issue : 3 | Page : 346-353An
observational study of incidence, risk factors & outcome of
systemic inflammatory response & organ dysfunction
following major trauma
Author Name: Satish Balkrishna Dharap, Sanket Vishnu
Ekhande
Department of Surgery, Lokmanya Tilak Municipal Medical
College & General Hospital, Mumbai, India
 Publication Date: 08/01/2018

33.  Background & objectives: Trauma is known to lead to
systemic inflammatory response syndrome (SIRS) and
multiple organ dysfunction syndrome (MODS), which is often
a cause of late deaths after injury. SIRS and MODS have been
objectively measured using scoring systems. This prospective
observational study was carried out in a tertiary care hospital
in India to evaluate SIRS and MODS following trauma in
terms of their incidence, the associated risk factors and the
effect on the outcome.

Methods: All adult patients with major life- and limb-
threatening trauma were included. Patients who died within 24
h, those with severe head injury, known comorbidity,
immunocompromised state, on immunosuppressants or
pregnancy were excluded. SIRS and MODS scores were
recorded after initial management (baseline score), on days 3
and 6 of admission. SIRS was defined as SIRS score of ≥2 and
MODS was defined as MODS score of ≥1.

34.  Results: Two hundred patients were enrolled. SIRS was noted
in 156 patients (78%). MODS was noted in 145 (72.5%)
patients. Overall mortality was 39 (19.5%). Both SIRS and
MODS scores were significantly associated with age >60 yr,
blunt injury, (lower) revised trauma score hypotension on
admission and (higher) injury severity score, but not with
gender, pre-hospital time or operative treatment.
Interpretation & conclusions: Both SIRS and MODS scores
were associated with longer Intensive Care Unit (ICU) stay,
more ICU interventions and higher mortality. Incidence of
MODS was significantly higher in patients with SIRS. Both
scores showed rising trend with time in non-survivors and a
decreasing trend in survivors. The serial assessment of scores
can help prognosticate outcome and also allocate appropriate
critical care resources to patients with rising scores.

35.  We have covered the following points in today’s
seminar:
 Introduction
 Definition of MODS & SEPSIS
 Risk and Etiological factors
 Classification & Pathophysiology of MODS
 Clinical Manifestations
 Diagnostic Evaluation
 Management
 Complications
 Nursing Management & Research article

36.  Multiple organ failure is the commonest cause of death
in the intensive care unit setting. There are numerous
precipitating factors including sepsis, trauma and
pancreatitis. The resulting tissue hypoxia, exaggerated
inflammatory response and generation of free oxygen
radicals leads to tissue damage and organ dysfunction.

37.  No definitive treatment for MODS. Management still
revolves around support of organ function and
prevention of iatrogenic complications until recovery
occurs.
An increasing emphasis is being placed on prevention
of organ dysfunction, including maintenance of tissue
oxygenation, nutrition and infection control.

38. BOOKS
 Medical surgical nursing, Brunner and suddarths published
by Wolters Kluwer (India) PVT LTD 2010 fifth edition, pg.
no.273-275.
 Medical surgical nursing clinical management for positive
outcome jayce M. Black Jane Hokanson Hawks, published
by Elsevier, a division of reed Elsevier India Privet Limited
2007, 7th edition, pg. no.1744-1749
 Medical surgical nursing, BT Basavanthappa, jaypee
brother’s medical publishers (P) New Delhi 2003, first
edition, pg. no. 225-228

39.  Medical surgical nursing, BT Basavanthappa, jaypee
brother medical publisher (P) new Delhi 2009 2nd edition,
pg. no. 628-631
JOURNAL
1. International Journal Of Surgery Open.
2. Indian Journal Of Medical Research.
SITES:
 https://en.wikipedia.org/wiki/Multiple_organ_d
ysfunction_syndrome
 https://www.slideshare.net/drjayeshpatidar/m
ulti-organ-dysfunction-syndrome
 https://www.slideshare.net/AkinbiOlubayodeo/
multiple-organ-dysfunction-syndrome-
65476967