By Dr. Prashant Borade
A multiple organ system failure is a misnomer and implies irreversible damage to organs. The appropriate terminology is Multiple Organ Dysfunction Syndrome (MODS) which is reversible and can be treated once the primary disease causing it is treated as early as MODS is diagnosed.
The pathophysiological mechanism of MODS is complex and is still not completely understood. Several definitions and scoring systems have described MODS since the condition came into existence. Lately clinicians corelated MODS with SOFA (Sequential Organ Failure Assessment) score, which is based on patient’s laboratory and clinical data. Apart from diagnosing MODS, the SOFA scoring is used to predict mortality of patients having MODS.
Most common cause of MODS is Infections causing septicemia followed by septic shock. Shock is a state where patient’s blood pressure falls below a particular level reducing the flow of blood to organs thereby reduce oxygen and nutrient supply to cells causing cell dysfunction and release of inflammatory chemicals from cells, leading to organ dysfunction. Dysfunction of more than two organs may lead to MODS. Shock and MODS can be caused by several other conditions apart from infection like, severe injury, heart failure, catastrophic bleeding etc. Patients suffering from MODS are already critically ill and usually are hospitalized in Intensive Care Units.
What are the Symptoms of MODS
MODS symptoms include low to high grade fever, high pulse or heart rate (tachycardia), and high breathing rate (tachypnea) in the first few hours. This may be followed by reduced blood pressure (BP) requiring medicines to increase BP due to heart and circulatory system dysfunction. Soon kidney dysfunction with reduction in urine output, reduce oxygen saturation and altered CO2 levels due to lung dysfunction follows. Further symptoms may include, increase sleep followed by coma due to brain cells dysfunction also called encephalopathy, increase bleeding tendency & low platelets due to bone marrow and liver dysfunction and so on to involve most or all organs in tandem or at short interval all together.
What Is the Best Path to Multiple Organ Failure Recovery?
Currently, there is no drug or therapy that can treat organ dysfunction. However, organ function can recover once primary clinical condition causing MODS is diagnosed and treated early. Medical researchers have discovered that some organs recover better and faster than others. Best treatment is to support the organs which have dysfunction, with medicines or organ support equipment’s like dialysis for kidneys, mechanical ventilation for lungs, ECMO (extra-corporeal membrane oxygenation) for heart and lungs etc. The support may be required till primary condition like infection or shock, or injuries are treated completely.
Multiple organ failure recovery can be a slow and challenging process. Early detection is very important when treating MODS. ICU treatment in any hospital is typically only the first stage of treatment and recovery. Once a patient has moved into transitional care several weeks and months of support is required from various other departments like physiotherapy, occupational therapy, dietitians, and respiratory therapist with regular follow up with specialist doctors. Recently research have shown the expedition in patients’ recovery in later stages with early mental health therapist and psychologists. Family’s assistance to patient in the form of moral, physical, emotional support and their patience in the whole treatment and recovery period is of paramount importance.
(The author is Director Critical Care Services, Global Hospitals. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)