Abstract
Introduction: Sepsis and multiple organ dysfunction syndrome (MODS) are considered clinical scenarios that most commonly seen in the critically ill patients in surgical settings. Developments in medicine have led to elder population, and have let critically ill and injured patients to survive, only to develop sepsis afterwards. It is estimated one million cases of sepsis in the US every year.
Sepsis as a separate clinical entity was first described by Bone and coworkers in 1989, and can be recognized as the invasion of microorganisms and/or their toxins into the patient's bloodstream, in consideration to the patient's response to that infection is characterized by systemic inflammation. Sepsis is considered a hemostatic dysregulation and endothelial dysfunction, leading to compromise of both the circulatory system and intracellular homeostasis. The end result is cellular hypoxia and programmed cell death (apoptosis) which are responsible for organ dysfunction and death.
Aim of work: In this review, we will discuss the most recent evidence regarding the multiple organ failure in patients in the intensive care unit
Methodology: We did a systematic search for Multiple organ failure in patients in the intensive care unit using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). We only included full articles.
Conclusions: Sepsis and MODS remain to be an important cause of morbidity and mortality in the ICU settings. Sepsis includes the interaction between the infectious insult and the patient's inflammatory response, both of which are essential factors in the progression along the spectrum from sepsis to MODS. The inflammatory response is a complex one, that is known by a procoagulant state, endothelial injury, cardiac dysfunction, vasodilation, hypovolemia due to fluid shift, microcirculatory dysfunction, and hemodynamic collapse. MODS is usually manifest when this process results in the dysfunction or failure of more than one organ system. The recent standards of therapy for sepsis have been established, which adds a outline for evidencebased care. Timely recognition of the signs and symptoms of early sepsis, aggressive volume resuscitation to established endpoints, and appropriate support with vasopressors and antimicrobial medications are the goals of early resuscitative efforts. Eradication of the infection by achieving source control and providing proper antibiotic therapy is critical to the resolution of the septic process. In patients who progress to MODS, the clinician must work to support and maintain the homeostasis of the failing organ systems. Mortality rates from septic shock and MODS are getting better, but continue to be high. Doctors must embrace the reality that not all can be saved.