Multiple organ dysfunction syndrome: a narrative review

Purpose: To review multiple organ dysfunction syndrome withrespect to: 1) c linical measurement systems; 2) molecular mechanisms; and 3) therapeutic di rections based upon molecular mechanisms. Methods: The Medline, Cochrane, and Best Evidence databases (1996 to 2000), conference proceedings, bibliographies of review articles were searched fo r relevant articles. Key index words were multiple organ failure, multiple system organ dysfunction, sepsis, septic shock, shock, systemic inflammator y response syndrome. Outcomes prospectively defined were death and physiolo gical reversal of end organ failure. Results: Multiple organ dysfunction/failure (MODS) is the most common cause for death in intensive care units. The recognition of this syndrome in the last 30 yr may be due to advances in early resuscitation unmasking these d elayed sequelae in those that would have died previously Multiple organ dys function occurs after shock oi varied etiologies and may be the result of u nbridled systemic inflammation. Ps yet, therapy directed to prevent or impr ove MODS has not dramatically altered outcomes. Conclusion: Multiple organ dysfunction may serve as useful measure of disea se severity for risk adjustment and outcome marker for quality of care and therapy provided. Anesthesiologists treating shock patients will note the s ubsequent development of MODS in the critical care unit and may be required to provide anesthetic support to these patients.