mods

1. Multiple Organ Dysfunction Syndrome Tianjin Medical University General Hospital Emergency Center

8. Male 26y Post-subtotal excision of colon Ileocolonic stoma leakage Multiple intestinal fistula

9. Abdominal abscess

10. Long-term application of high caloria parenteral nutrition ( fat emulsion) liver tumefaction liver dysfunction SGPT 36 SGOT 144 TB 167.9 DB 102.8

12. septic shock Renal function BUN 20.5 Cr 337 need inhalation of oxygen with mask continuous hemofiltration tracheotomy ventilator application

13. Definition

18. Pathogenesis

21. Systemic Inflammatory Response Syndrome (SIRS)

22. SIRS with a presumed or confirmed infectious confirmed infectious process sepsis SIRS Infection Severe sepsis Bacteremia

23. Severe sepsis MODS The presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention Death Sepsis with  1 sign of organ failure Cardiovascular (refractory hypotension) Renal Respiratory Hepatic Hematologic CNS Metabolic acidosis Shock

24. SIRS,CARS and MODS

27. SIRS CARS CARS MODS SIRS CARS SIRS CARS MODS SIRS

28. Initial insult Bacteria. Viral trauma Local Pro-inflammatory response Local Anti-inflammatory response Systemic spillover of pro-inflammatory mediators Systemic spillover of anti-inflammatory mediators Systemic Reaction SIRS (pro-inflammatory ) CARS(anti-inflammatory ) Homeostasis SIRS & CARS balanced Cardiovascular compromise （ shock ） SIRS predominates Apoptosis (cell death) SIRS predominates Organ dysfunction SIRS predominates Suppression of the immune system CARS predominates

29. SIRS SIRS CARS SIRS CARS CARS SIRS CARS MARS

30. Heat Redness Swelling Pain Loss Of Func .

33. Diagnosis

36. Gastrointestinal Dysfunction Hypoperfusion Ischemia of the gut Decreased integrity of the gut lining Decreased peristalsis Translocation of normal GI bacteria into systemic circulation Colonization of normal GI flora up into the orpharynx Systemic infection and SIRS Aspiration of bacteria and initiation of a inflammatory response in the lung

37. Hepatobiliary Dysfunction Hypoperfusion Ischemia of the liver and gallbladder ischemic hepatitis acalculous cholecystitis Jaundice serum transaminase serum bilirubin Right upper pain and tenderness Abdominal distention Unexplained fever Loss of bowel sounds

39. Renal Dysfunction Hypoperfusion And Renal toxic drugs Ischemia of the Kidney Azotemia Creatinine clearance Fluid and electrolyte imbalances Fluid volume overload Renal Function

42. Central Nervous System Bispectral EEG monitoring Altered level of consciousness Impaired mentation Confusion Delirium Psychosis Lab Clinical

43. Metabolic/Nutritional Negative nitrogen balance Hyperglycemia Hypertriglyceridemia Increased serum lactate Decreased serum albumin,serum transferrin,prealbumin Decreased retinol-binding protein Decreased lean body mass Muscle wasting Severe weight loss Lab Clinical

44. Immune Decreased lymphocyte anergy Nosocomial Infection Pyrexia Lab Clinical

45. Tachycardia Hypotension  CVP  PAWP  Enzyme  Albumin  PT Irritability Alteration confusion Somnolence Coma Tachypnea PaO 2 <70 mm Hg SaO 2 <90% PaO 2 /FiO 2  300 Oliguria Anuria  Creatin  Platelet  PT/APTT  Protein C  D-dimer

46. Prevention

48. Prognosis

49. Marshall assessment system （ 1995 ） organ score 0 1 2 3 4 PaO 2 /FiO 2 ≥ 40.0 30.1~40.0 20.1~30.0 10.1~20.0 ≤ 10.0 CRE ， μmol/L ≤ 100 101~200 201~350 351~500 >500 BIL ， μmol/L ≤ 20 21~60 61~120 121~240 >240 HR ，次 /min ≤ 10.0 10.1~15.0 15.1~20.0 20.1~30.0 >30.0 BPC ， ×10 9 /L >120 81~120 51~80 21~50 ≤ 20 GCS 15 13~14 10~12 7~9 ≤ 6

51. The relationship between MODS score and the mortality of patients in ICU MODS score mortality(%) 0 0 9~12 25 13~16 50 17~20 75 >20 100

52. Treatment

63. Thank you