The multiple organ dysfunction syndrome (MODS), though newly described,
has mmifested itself in intensive care unit (ICU) patients for several decades.
As the name implies, it is a syndrome in which more than one organ system
fails. Failure of these multiple organ systems may or may not be related to the
initial injury or disease process for which the patient was admitted to the ICU.
MODS is the leading cause of morbidity and mortality in current ICU practice.
While the pathophysiology of MODS is not completely known, much evidence
indicates that, during the initial injury which precipitates ICU admission, a
chain of events is initiated which results in activation of several endogenous
metabolic pathways. These pathways release compounds which, in and of
themselves, are usually cytoprotective. However, an over exuberant activation
of these endogenous systems results in an inflammatory response which can
lead to development of failure in distant organs. As these organs fail, they activate
and propagate the systemic inflammatory response.
No therapy has proven entirely efficacious at modulating this inflammatory
response and the incidence and severity of MODS. In current ICU practice,
treatment is focused on prevention and treating individual organ dysfunction as
it develops. With increased understanding of the pathophysiology of MODS
therapy will come newer modalities which inhibit or interfere with the propagation
of the endogenous systemic inflammatory response. These newer therapies
hold great promise and already some are undergoing clinical investigation.