An Overview of Multiple Organ Dysfunction Syndrome
Published: 25 May 2020
Multiple organ dysfunction syndrome (MODS) carries a serious risk of mortality.
In order to prevent it from progressing to an irreversible stage, immediate detection and treatment are crucial (Procter 2019).
What is Multiple Organ Dysfunction Syndrome?
Multiple organ dysfunction syndrome (MODS) is defined as the progressive physiological dysfunction of two or more organ systems where homeostasis cannot be maintained without intervention (Osterbur et al. 2014; Nickson 2019).
MODS is generally initiated by illness, injury or infection, causing a state of immunodepression and hypometabolism (Nickson 2019).
Rather than a single event, MODS is considered a continuum where the extent of dysfunction can vary greatly from mild impairment to irreversible failure (Al-Khafaji 2020).
Organs most commonly affected by MODS include the heart, lungs, liver and kidneys (Gu et al. 2018).
It is associated with significant mortality and morbidity, estimated to affect around 15% of ICU patients and contributing to about 50% of deaths in ICU (Nickson 2019; Osterbur et al. 2014).
Causes of Multiple Organ Dysfunction Syndrome
MODS is induced by illness, injury or infection that triggers an unregulated systemic inflammatory response (known as systemic inflammatory response syndrome), resulting in tissue injury (Harper & Saeb-Parsy 2013; Rossaint & Zarbock 2015).
The most common trigger is sepsis, but other causes include:
Acute heart failure; and
(Nickson 2019; Wang et al. 2017; Harjola et al. 2017)
Risk Factors for Multiple Organ Dysfunction Syndrome
An individual’s genetics may dictate the likelihood and severity of MODS following a trigger.
A patient with premorbid organ dysfunction may be prone to further deterioration.
Medications, therapies and ICU supports may contribute to organ injuries.
A patient with an infection is at risk of MODS.
How to Assess for Multiple Organ Dysfunction Syndrome
Undertake a systems approach assessment (head-to-toe assessment).
Document and analyse data from the patient’s vital signs, taking into account any trends.
A SOFA score can be used in line with other assessment tools.
Presentation and Symptoms of Multiple Organ Dysfunction Syndrome
In order to be diagnosed with MODS, the patient should be experiencing dysfunction of at least two organs (this may be mild or severe) in addition to systemic inflammatory response syndrome (Nickson 2019).
Organ dysfunction may present as:
Acute kidney injury (AKI) and uraemic acidosis;
Acute respiratory distress syndrome (ARDS);
Coagulopathy and bone marrow suppression; and
Acute neurological dysfunction.
The patient may display some of the following symptoms depending on which organs are affected:
An altered mental state;
A decrease in renal perfusion (decrease in urine output);
As a complication of an illness, injury or infection, MODS is difficult to prevent. Early recognition improves patient outcomes - this is the only way to prevent damage.
It is important to monitor patients closely and administer appropriate therapies to facilitate organ function (Al-Khafaji 2020).
Maintain an accurate fluid balance chart;
Support the haemodynamic needs of the patient (identify low blood pressure, analyse trends, escalate to the medical team and treat early);
Identify any potential triggers of MODS;
Ensure regular blood tests are performed; and
Decrease the risk of further organ damage if MODS is identified through early implementation of care.
Complications of Multiple Organ Dysfunction Syndrome
While MODS itself is the complication of an underlying condition, it represents a spectrum of dysfunction and can rapidly increase in severity (Wang et al. 2017).
In the later stages of MODS, the affected organs may completely lose function (multiple organ failure). This carries a mortality risk of up to 80 to 96% and may not be reversible. Preventing MODS from progressing into organ failure is therefore crucial (Wang et al. 2017).
If the patient becomes increasingly unwell, they may require intensive care admission and aggressive treatment to maximise organ function.
MODS is a serious condition and can be life-threatening if not addressed early. If a patient presents with MODS, escalate care as necessary and support the affected organs.
Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your facility's policy on preventing and responding to deterioration and multiple organ dysfunction syndrome.
Harjola, V et al. 2017, Organ Dysfunction, ‘Injury and Failure in Acute Heart Failure: From Pathophysiology to Diagnosis and Management. A Review on Behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)’, European Journal of Heart Failure, vol. 19 no. 7, viewed 20 May 2020, https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.872