Abstract
Multiple organ dysfunction syndrome (MODS) is characterized by progressive but potentially reversible physiologic dysfunction of two or more organ systems following resuscitation from an acute life-threatening event. Improved understanding of the pathogenesis of MODS has led to the development of new therapies that place importance on early identification and aggressive management. Our understanding of MODS has grown enormously over the past two decades. Presently MODS is deemed to be as much a disease paradigm as a syndrome that follows systemic activation of an adaptive host stress response to a catastrophic event. The exaggerated systemic inflammatory host response, induced by the infecting organisms or a non-infective insult, unleashes inflammatory mediators that are the key players in the pathogenesis of systemic inflammatory response syndrome (SIRS) and MODS. Sepsis, SIRS and their sequela, MODS, represent a continuum of clinical syndromes encompassing systemic inflammation, coagulopathy and hemodynamic abnormalities. The injurious insult to the human body promotes a vicious cycle of anomalous metabolic molecular physiology comprising increased oxygen demand and inadequate oxygen supply. Standard MODS therapy includes supportive treatment such as fluid resuscitation, administration of vasopressors (adrenergic and non-adrenergic drugs), and respiratory and renal support. This review emphasizes approaches to the early recognition, diagnosis and therapeutic management of sepsis and ensuing MODS, giving the clinician the most contemporary and practical approaches with which to treat these patients.