Multiple Organ Syndrome

DRG Category: 101

Mean LOS: 4.6 days

Description: OTHER: Respiratory System

Diagnoses with CC (If the patient develops this syndrome during the hospital stay, the reason for admission will determine the DRG assigned.)

IVI ultiple organ dysfunction syndrome (MODS) occurs when altered organ function in an acutely ill patient is present to the extent that homeostasis can no longer be maintained without intervention. MODS was formerly known as multiple-system organ failure. The usual sequence

628 Multiple Organ Dysfunction Syndrome of MODS depends somewhat on its cause but often begins with pulmonary failure 2 to 3 days after surgery, followed, in order, by hepatic failure, stress-induced gastrointestinal (GI) bleeding, and renal failure. Mortality rates are linearly related to the number of failed organ systems. Patients with two or more organ systems involved have a mortality rate of approximately 75%, and patients with four organ systems involved have a 100% mortality rate.

MODS was first associated with traumatic injuries in the late 1960s and has subsequently been associated with infection and decreased perfusion to any part of the body. The term MODS was adopted in 1991 at a consensus conference of the Society of Critical Care Medicine and the American College of Chest Physicians. The term MODS best describes the organ dysfunction that precedes complete failure. Primary MODS, the result of a direct injury or insult to the organ itself, is initiated by a specific precipitating event, such as a pulmonary contusion. The injury or insult causes an inflammatory response within that organ system, and dysfunction develops.

Secondary MODS develops as the result of a systemic response to infection or inflammation. Systemic inflammatory response syndrome (SIRS) is an overwhelming response of the normal inflammatory system, producing systemic effects instead of the localized response normally seen. The inflammatory response is produced by the activation of a series of mediators and results in alterations in blood (selective vasodilation and vasoconstriction), an increase in vascular permeability, white blood cell (WBC) activation, and activation of the coagulation cascade. Mortality rates are high with MODS, and the more organ systems that fail, the higher the mortality. For example, mortality with two-organ failure is 45% to 55%, higher than 80% with three-organ failure, and approaches 100% if the failure of three or more organs persists longer than several days.

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