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January 19, 1994, Vol 271, No. 3 >
ARTICLE | January 19, 1994

Multiple Organ Failure Syndrome in the 1990s: Title and subTitle BreakSystemic Inflammatory Response and Organ Dysfunction FREE

Alan L. Beal, MD; Frank B. Cerra, MD
[+] Author Affiliations

Reprint requests to the Department of Surgery, University of Minnesota Medical School and University of Minnesota Hospital and Clinic, 406 Harvard St SE, Box 42, Minneapolis, MN 55455 (Dr Cerra).


JAMA. 1994;271(3):226-233. doi:10.1001/jama.1994.03510270072043
Text Size: A A A
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Article
References

Objective.  —This review of the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) provides an overview of a common but complex problem found in critically ill patients. It emphasizes definitions, common clinical patterns, metabolic responses, and pathophysiological changes. A brief discussion of treatment concepts is also included.

Data Sources.  —Data for this review were gathered from peer-reviewed journals, review articles by experts in SIRS/MODS, and selections from reference volumes written on SIRS/MODS.

Study Selection.  —Reference selections were chosen on the basis of quality of research. Peer-reviewed journals were given primary consideration. Those review articles cited were felt to be essential to any discussion of SIRS/MODS.

Data Extraction.  —Where possible, randomized, controlled, prospective studies were reviewed and conclusions used in this overview of SIRS/MODS.

Conclusion.  —Our ability to care for critically ill patients has led to a new problem, SIRS and eventually MODS, which may become progressive organ failure and death. Unfortunately, these conditions are extremely frequent and carry high mortality rates. Increased oxygen consumption demands highlight the physiological response. The typical metabolic responses are characterized by hyperglycemia and accelerated protein catabolism. Unrecognized perfusion deficits, an uncontrolled septic focus, a persistent source of inflammation, or injured tissue is commonly present with SIRS/MODS and should be corrected. Restoration of oxygen transport and metabolic support are also important components of treatment. The cause of SIRS/MODS is complex and not fully understood, but multiple mediators and stimulated macrophages likely are important components and areas where treatment may well be focused.(JAMA. 1994;271:226-233)

REFERENCES

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Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Eyer SD, Cerra FB.  Cost effective use of the surgical intensive care unit. World J Surg . 1987;; 11:241-247.
2 +
Siegel JH, Cerra FB, Moody EA, et al.  Effect of survival in critically ill and injured patients of an ICU teaching society organized around a physiological care system. J Trauma . 1980;;20:558-579.
3 +
Faist E, Baue AE, Dittmer H, Heberer G.  Multiple organ failure in polytrauma patients. J Trauma . 1983;;23:775-787.
4 +
Pine RW, Wertz MJ, Lennard ES, Dellinger EP, Carrico CJ, Minshew BH.  Determinants of organ malfunction or death in patients with intra-abdominal sepsis: a discriminant analysis. Arch Surg . 1983;; 118:243-249.
5 +
Manship L, McMillan RD, Brown JJ.  The influence of sepsis and multisystem organ failure on mortality in the SICU. Am Surg . 1984;;50:94-101.
6 +
Baker C, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD.  Epidemiology of trauma deaths. Am J Surg . 1980;;140:144-150.
7 +
Tilney NL, Bailey GL,  Morgan Ap. Sequential system failure after rupture of AAA: an unsolved problem in postoperative care. Ann Surg . 1973;; 178:117-122.
8 +
Baue AE.  Multiple, progressive or sequential systems failure: a syndrome of the 1970s. Arch Surg . 1975;;110:779-781.
9 +
Eiseman B, Beart R, Norton L.  Multiple organ failure. Surg Gynecol Obstet . 1977;;144:323-326.
10 +
Bone RC.  Multiple system organ failure and the sepsis syndrome. Hosp Pract . 1991;;26:101-126.
11 +
Cerra FB.  The systemic septic response: concepts of pathogenesis. J Trauma . 1990;;30:S169-S174.
12 +
Cerra FB.  Hypermetabolism, organ failure and metabolic support. Surgery . 1987;;101:1-14.
13 +
Bone RC, Balk RA, Cerra FC, et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest . 1992;; 101:1644-1655.
14 +
Henao FJ, Daes JE, Dennis RJ.  Risk factor for multiorgan failure: a case-control study. J Trauma . 1991;;31:74-80.
15 +
Marshall WG, Dimick AR.  The natural history of major burns with multiple subsystem failure. J Trauma . 1983;;23:102-105.
16 +
Aikawa N, Shinozawa Y, Ishibiki K.  Clinical analysis of multiple organ failure in burned patients. Burns . 1987;;13:103-109.
17 +
Pepe PE, Potkin RT, Reus DH, Hudson LO, Carrico CJ.  Clinical predictors of the adult respiratory distress syndrome. Am J Surg . 1982;;144: 124-130.
18 +
Allardyce DB.  Incidence of necrotizing pancreatitis and factors related to mortality. Am J Surg . 1987;;154:295-299.
19 +
McFadden DW.  Organ failure and multiple organ system failure in pancreatitis. Pancreas . 1991;; 6:S37-S43.
20 +
Knaus WA, Draper EA, Wagner DP, Zimmerman JE.  Prognosis in acute organ system failure. Ann Surg . 1985;;202:685-693.
21 +
Bone RC, Balk R, Slotman G, et al.  ARDS: sequence and importance of development of multiple organ failure. Chest . 1992;;101:320-326.
22 +
Madoff RD, Sharpe SM, Fath JJ, Simmons RL, Cerra FB.  Prolonged surgical intensive care. Arch Surg . 1985;;120:698-702.
23 +
Raffin TA.  Intensive care unit survival of patients with systemic illness. Am Rev Respir Dis . 1989;;140:S28-S35.
24 +
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