Multiple organ failure: What you need to know

Abstract

Multiple organ failure (MOF) remains a significant challenge for the acute care surgeon, often leading to poor patient outcomes. This comprehensive review explores the etiology, pathophysiology, clinical presentation, diagnosis, management strategies, prognosis, and prevention strategies associated with MOF and chronic critical illness. Understanding the intricate etiology and pathophysiology of MOF and chronic critical illness is essential for effectively managing these syndromes and developing targeted treatment strategies aimed at mitigating the underlying inflammatory, immune, and microvascular disturbances, in order to redirect patients onto a trajectory of recovery.

Keywords: Multiple organ failure; chronic critical illness; immune dysfunction.

Figure 1.

Mechanisms and end-organ manifestations of MOF. Tissue injury, infection and shock trigger the release of inflammatory mediators, damage (DAMPs) and pathogen associated molecular pattern (PAMPs) molecules into the systemic circulation and precipitate MOF. Organ crosstalk from failing organs spreads and perpetuates dysfunction across multiple organ systems.

Figure 2.

Immune dysregulation, MOF, CCI, and the persistent inflammation, immunosuppression and catabolism syndrome (PICS). Trauma, sepsis or surgical injury triggers a “genomic storm” of immune gene expression in circulating peripheral leukocytes that can trigger MOF. The predominant trajectory of morbidity and mortality of MOF has transitioned from early death, to survival with CCI, and dismal long-term outcomes.