Multi Organ Failure
muli organ

What is Multi Organ Failure?

Progressive failure in function of multiple vital organs in the body that may be either irreversible or reversible and certainly demands urgent care

Who treats Multi Organ Failure?

Intensivists, Internal Medicine Specialists

What are the different types of Multiple Organ Failures?

  • Early / Primary – Develops within 7 days of illness or trauma
  • Late / Secondary –Develops 7 days after the illness or trauma

What are the systems that fail during multiple organ failure?

Respiratory, Cardiovascular, Renal, Haematological, Hepatic, Gastrointestinal, Musculoskeletal and Central Nervous Systems

What causes organ dysfunction?

  • Sepsis & Septic shock
  • Infections
  • Respiratory failure
  • Severe Trauma – TBI and Non-TBI
  • Severe Burns
  • Compromised circulation / Hypoperfusion
  • Tropical Diseases
  • Heat stroke
  • Drug overdose

What are the risk factors for developing Multi Organ Failure?

  • Low immunity
  • Delayed resustication
  • Poor nutrition status
  • Diabetes
  • Delayed diagnosis

What are the symptoms of Multi Organ failure?

  • Fever
  • Chills
  • Bleeding tendencies
  • Disorientation or confusion
  • Anxiety and Agitation
  • Confusion & Psychosis
  • Altered Consciousness
  • Sweating
  • Rapid breathing
  • Low blood pressure
  • Constipation
  • Low or no urine output

What are the complications and consequences of Multi Organ Failure?

  • Immuneparalysis / Immune System Dysfunction
  • Hormonal Imbalance
  • Metabolic Dysregulation
  • Mitochondrial Dysfunction
  • Microvascular Dysfunction
  • Epithelial Dysfunction
  • Metabolic encephalopathy
  • Acid Base Imbalance
  • Acute Lung Injury
  • Acute Respiratory Distress Syndrome
  • Hepatic Encephalopathy
  • Acute kidney injury
  • Paralytic Ileus
  • Anaemia
  • Thrombocytopenia
  • Disseminated Intravascular Coagulation
  • Coagulopathy / Coagulation Activation
  • Cytopathic anoxia
  • Immunosuppression

How is Multi Organ Failure Diagnosed and Monitored during recovery?

  • Symptoms Evaluation & Differential Diagnosis
  • Vital Signs Evaluation & Pulse Oximetry
  • Arterial Blood Gases Measurement and Monitoring
  • Lab Tests – Complete Blood Profile, Complete Metabolite Profile, Urine analysis & output, blood lactate, base excess, blood glucose, central venous oxygen saturation, Liver Function Tests, Serum Bilirubin, Serum Creatinine, D-Dimer, Coagulation Panel, Blood Urea Nitrogen, Troponin I, cerebrospinal fluid analysis blood cultures
  • Imaging – Thoracic ultrasonography, Echocardiography,
  • Electrophysiology Monitoring – Electrocardiography
  • Cystoscopy
  • Biopsies
  • Cytological analysis – Tracheal wash & Bronchoalveolar lavage fluid
  • Thromboelastography
  • Minimally Invasive Cardiac Output Monitoring
  • Sequential Organ Failure Assessment
  • Assessment through Multiple Organ Dysfunction Score
  • Assessment through Logistic Organ Dysfunction System Score
  • Assessment through Predisposition Infection Response Organ Dysfunction Score

What are the treatment options for Multi Organ Failure?

  • Medication – Diuretics, Antibiotics, Insulin, Vasopressors, Inotropic agents, Antiendotoxins, Gastrointestinal protectants and Antioxidants
  • Source control with early invasive and non-invasive interventions
  • Continuous renal replacement therapy
  • Low dose glucocorticoid hormone replacement therapy
  • Aggressive hydration
  • Early initiation of nutrition through enteral or parenteral routes along with arginine, glutamine, selenium, and omega-3 fatty acids supplementation
  • Extracorporeal Membrane Oxygenation
  • Transfusion of Blood products

What are the focus areas of critical care during Multi Organ Failure?

  • Adequate Nutritional and Fluid Support
  • Adequate mechanical ventilation support with optimal positive end-expiratory pressure
  • Glucose Control with Insulin therapy as needed
  • Prevention of Deep Vein Thrombosis
  • Prevention of Peripheral Oedema, Pulmonary Oedema and Cerebral Oedema
  • Prevention Stress or Pressure Ulcers
    • Extracorporeal Organ Support
      • Invasive and non-invasive mechanical ventilation
      • Veno-Venous Extracorporeal Membrane Oxygenation
      • Veno-Venous Extracorporeal Carbon Dioxide Removal
      • Mechanical circulatory support
        • Intra-aortic balloon pump
        • Percutaneous / Surgical Ventricular Assist Devices
        • Veno-Arterial Extracorporeal Membrane Oxygenation
        • Total Artificial Heart
        • Extracorporeal liver support
        • Renal Replacement Therapy
          • Continuous Veno-Venous Hemodialysis (CVVHD)
          • Continuous Veno-Venous Hemofiltration (CVVH)
          • Continuous Veno-Venous Hemodiafiltration (CVVHDF)
          • Sustained Low Efficiency Hemodialysis (SLEHD)
      • Plasmapheresis or Plasma Exchange
      • Continuous Plasma Filtration Adsorption
      • Albumin Haemodialysis
      • Slow Continuous Ultrafiltration
      • Hemoperfusion
  • Minimizing Blood Transfusions
  • Preventive and Therapeutic measures for Catheter related Infections
  • Preventive and Therapeutic measures for Ventilator associated Pneumonia

Renal Replacement Therapy

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