MODS- Multiple Organ Dysfunction Syndrome & SIRS - Systemic Inflammatory Response Syndrome Notes Flashcards Preview

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Flashcards in MODS- Multiple Organ Dysfunction Syndrome & SIRS - Systemic Inflammatory Response Syndrome Notes Deck (21)
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1

Systemic inflammatory response syndrome (SIRS)

Systemic inflammatory response to a variety of insults, including infection (referred to as sepsis), ischemia, infarction, and injury.

2

Mechanisms that can trigger SIRS

• Mechanical tissue trauma: burns, crush injuries, surgical procedures
• Abscess formation: intraabdominal, extremities
• Ischemic or necrotic tissue: pancreatitis, vascular disease, MI
• Microbial invasion: bacteria, viruses, fungi, parasites
• Endotoxin release: gram-negative and gram-positive bacteria
• Global perfusion deficits: postcardiac resuscitation, shock states
• Regional perfusion deficits: distal perfusion deficits

3

Multiple organ dysfunction syndrome (MODS)

failure of 2 or more organ systems in an acutely ill patient such that homeostasis cannot be maintained without intervention

4

Respiratory System Manifestations

ARDS
• Bilateral fluffy infiltrates on chest x-ray
• Decreased compliance
• Dyspnea (severe)
• Increased minute ventilation
• PaO2/FIO2 ratio <200
• PAWP <18 mm Hg
• Pulmonary hypertension
• Refractory hypoxemia
• Tachypnea
• Ventilation-perfusion (V/Q) mismatch

5

Respiratory System Management

Optimize O2 delivery and minimize O2 consumption
Mechanical ventilation
• Positive end-expiratory pressure
• Lung protective modes (e.g., pressure-control inverse ratio ventilation, low tidal volumes)
• Permissive hypercapnia
• Positioning (e.g., continuous lateral rotation therapy, prone positioning)

6

Cardiovascular System Manifestations

Biventricular failure
↓ BP, MAP, SVR
↑ HR, CO, SV
Massive vasodilation
Myocardial depression
Systolic, diastolic dysfunction

7

Cardiovascular System Management

Volume management to ↑ preload
Hemodynamic monitoring
Arterial pressure monitoring to maintain MAP >65 mm Hg
Vasopressors
Intermittent or continuous ScvO2 or SvO2 monitoring
Balance O2 supply and demand
Continuous ECG monitoring
Circulatory assist devices
VTE prophylaxis

8

CNS Manifestations

Acute change in neurologic status
Confusion, disorientation, delirium
Fever
Hepatic encephalopathy
Seizures

9

CNS Management

Evaluate for hepatic or metabolic encephalopathy
Optimize cerebral blood flow
↓ Cerebral O2 requirements
Prevent secondary tissue ischemia
Calcium channel blockers (reduce cerebral vasospasm)

10

Endocrine System Manifestations

Hyperglycemia → hypoglycemia

11

Endocrine System Management

Provide continuous infusion of insulin and glucose to maintain blood glucose 140–180 mg/dL (7.77–10.0 mmol/L)

12

Renal System: prerenal Manifestations

Prerenal: renal hypoperfusion
• BUN/creatinine ratio >20:1
• ↓ Urine Na+ <20 mEq/L
• ↑ Urine osmolality
• Urine specific gravity >1.020

13

Renal System: prerenal Management

Diuretics
• Loop diuretics (e.g., furosemide [Lasix])
• May need to ↑ dosage due to ↓ glomerular filtration rate

14

Renal System: intrarenal manifestations

Intrarenal: acute tubular necrosis
• BUN/creatinine ratio <10:1–15:1
• ↑ Urine Na+ >20 mEq/L
• ↓ Urine osmolality
• Urine specific gravity ∼1.010

15

Renal System: intrarenal management

Continuous renal replacement therapy

16

GI manifestations

GI bleeding
Hypoperfusion → ↓ peristalsis, paralytic ileus
Mucosal ischemia
• ↓ Intramucosal pH
• Potential translocation of gut bacteria
• Potential abdominal compartment syndrome
Mucosal ulceration on endoscopy

17

GI Management

Stress ulcer prophylaxis

• Antacids (e.g., Maalox)
• Proton pump inhibitors (e.g., omeprazole [Prilosec])
• sucralfate (Carafate)
Monitor abdominal distention, intraabdominal pressures
Dietitian consult
Enteral nutrition
Stimulate mucosal activity
Provide essential nutrients and optimal calories

18

Hepatic System Manifestations

Bilirubin >2 mg/dL (34 μmol/L)
Hepatic encephalopathy
Jaundice
↑ Liver enzymes (ALT, AST, GGT)
↓ Serum albumin, prealbumin, transferrin
↑ Serum NH3 (ammonia)

19

Hepatic System Management

Maintain adequate tissue perfusion
Provide nutritional support (e.g., enteral nutrition)
Careful use of drugs metabolized by liver

20

Hematologic System Manifestations

↑ Bleeding times, ↑ PT, ↑ PTT
↑ D-dimer
↑ Fibrin split products
↓ Platelet count (thrombocytopenia)

21

Hematologic System Management

Observe for bleeding from obvious and/or occult sites
Replace factors being lost (e.g., platelets)
Minimize traumatic interventions (e.g., IM injections, multiple venipunctures)