Specific organ dysfunction
Respiratory dysfunction The lungs are a common site of injury in MODS. Lung injury may be either primary when the initial insult is to the lungs themselves (eg pulmonary contusions or aspiration pneumonia) or secondary, due to a non pulmonary disease process, (eg a septic intra-abdominal process or severe pancreatitis). Acute lung injury results in damage to the alveolar epithelium and/or the pulmonary capillary endothelium causing fluid leakage from blood vessels into the interstitium and alveoli leading to impaired gas exchange. The ensuing hypoxemia, hypercarbia, and the compromise of oxygen delivery to tissues, leads to further injury to other organ systems. Therapy for acute lung injury is aimed at maintaining gas exchange and supporting oxygen delivery. Fluid therapy should be titrated to maintain a cardiac output that is sufficient to ensure oxygen delivery while preventing fluid overload which can exacerbate the pulmonary edema.
Renal dysfunction The primary mechanism leading to the development of ARF appears to be acute tubular necrosis.This may result from toxins, including antibiotics, sepsis or long-standing hypovolaemia with resultant cellular ischemia and hypoxia resulting in damage to the glomerulus, renal tubular cells and the renal vasculature. Debris and casts in the tubular lumen can obstruct the renal tubules with the proximal tubules and thick ascending loop of Henle most seriously affected. Ischemic damage to the afferent and efferent arterioles can compromise blood flow autoregulation thereby worsening the effects of ischemia. Treatment of renal dysfunction is aimed at maintaining renal perfusion through adequate volume resuscitation and use of positive inotropes.
Cardiovascular dysfunction Cardiovascular dysfunction is common in people with MODS. In sepsis, this is recognized as decreased contractility with biventricular dilatation and decreased right and left ventricular ejection