Full-fledged and stable operation of all systems and organs in the human body is one of the key conditions of life. But under the influence of certain factors, the normal state of the body can be seriously threatened, leading to a fatal outcome. This is a multi-organ failure - a disease that has an extremely devastating effect on key body systems.
What is the risk of multiple organ failure?
Under this disease is to understand the severe nonspecific stress-reaction of the body with the total insufficiency of several functional systems. In this case, the progression of diseases occurs according to the principle of development of the majority of injuries and acute diseases at the terminal stage.
As a key feature of multi-organ failure, it is possible to determine the damage to the system or organ at such a level that it loses its ability to maintain the vital activity of the body. If we take the statistics of the intensive care units and the resuscitation of surgical hospitals, then the syndrome will account for up to 80% of all deaths.
Such an indicator as the severity of multiple organ failure is determined by considering the following factors: the initial functional state of the organ itself (directly depends on the physiological reserve), decreased blood flow, the organ's ability to withstand hypoxia, shock factors (septic, cardiogenic, hypovolemic), metabolic disorders.
Causes of the disease
Multiple organ failure may be the result of exposure to the body of various infections, injuries, hypermetabolism or tissue hypoperfusion. The presence of these factors does not yet guarantee the occurrence of the disease, but each of them has sufficient potential to lead to this disease. As for cellular damage, the mediators play an important role in them. The concentration with which it is necessary to deal with the release depends on the severity of the factor that has a damaging effect.
In some cases, transfusion of canned blood for long periods of storage in large quantities can also lead to a condition such as multi-organ failure. The causes of this disease are sometimes associated with unskilled artificial ventilation.
If we touch the sphere of surgery, then as the key causes of the stressful reaction of the body is to identify infectious, which cause a violation of metabolism, the immune status of patients and the system of homeostasis. PTS develops as a complication of the postoperative period (7-22%), as for purulent complications of acute inflammatory diseases, this diagnosis is made in 50% of cases.
Influence of infection on the development of multiple organ failure
Multiple organ failure may result from septic processes and impaired immunity. In most cases, sepsis develops because of the influence of gram-negative bacteria that enter the bloodstream and organs through the gastrointestinal tract. Therefore, the opinions of many researchers agree that the gastrointestinal tract plays the role of a generator of multi-organ failure.
The components of the development of the disease can be considered disorders of homeostasis, mediators of inflammation, microcirculation damage, bacterial toxins and endothelial damage.
Speaking about the clinical picture, the syndrome of multiple organ failure is divided into several key conditions:
Acute liver failure;
- violation of the functions of the central nervous system;
- adult respiratory distress syndrome;
- DIC-syndrome (it is also called the syndrome of disseminated intravascular coagulation).
The complications given above are the main causes of death in intensive care units. Depending on how many organs are in a state of insufficiency, the probability of death of patients changes.
As a key link that triggers the processes, which result in acute polyorganic insufficiency, it is possible to determine a metabolic disorder. This pathology is a response to systemic damage, regardless of which etiologic factor was the initial (polytrauma, burns, infection, ischemia).
Multiple organ failure can also be identified as the final stage of the hypermetabolic systemic response of the body to a particular injury that manifests itself by acute pulmonary disorder leading to the development of hepatic, renal insufficiency, as well as to the dysfunction of other human organs.
In the terminal stage of the disease, one can observe pronounced catabolism. The cause for its occurrence is the severe condition of the patient with an irreplaceable energy deficit. As a result, there is a development of protein-dependent energy metabolism, which is based on the breakdown of proteins and the activation of proteolysis of muscle tissue, as well as vital organs. The consequence of this process is the release of activated microbial and viral toxins, macrophages and mast cells of substances provoking cellular and tissue damage.
In this case, as a result of trauma, patients may develop a syndrome of a systemic inflammatory response, the severity of which depends on the volume of the affected tissue, the degree of shock and the innate properties of the organism itself.
Multiple organ failure: developmental phases
Progressing, the PON syndrome consistently goes from one phase to another:
1. Induction. At this stage, a synthesis of various humoral factors is formed that trigger the response of the systemic inflammatory response.
2. Cascading. This phase is accompanied by the activation of the kallikrein-kinin system, the development of acute pulmonary injury, and the activation of cascades of the blood coagulation system and the arachidonic acid system.
3. The secondary phase of autoaggression. At this stage, there is an extremely severe organ dysfunction and stable hypermetabolism. At this time there is a loss of body ability to self-regulation of homeostasis.
ICD. Multiple organ failure
In order to clearly understand the essence of the diagnosis delivered by the doctor, it is worth familiarizing yourself with the system of special codes contained in the International Classification of Diseases and Health Problems.
The system of hierarchy of diseases in this case lends itself to simple logic. First comes the letter designation (Latin alphabet), which defines a group of diseases, for example, the pathology of the circulatory system. Then follows a numerical code of two digits, indicating a particular ailment. The third symbol carries information about some kind of disease or its complication.
Many people are interested in what type of multi-organ failure ICD-10 has? It should be noted that this pathology does not have a code as such, since it is associated with exposure to various systems and organs. Nevertheless, the characteristics of the stress response can be found in several categories of classification. In other words, the International Disease Detection System gives a characteristic of this state, but collectively.
Renal failure is directly associated with a disease such as multiple organ dysfunction (ICD-10, N 19). Actual is N 17, which is attributed to acute renal failure, which is a component of multi-organ. It makes sense to mention and K 85 - acute pancreatitis.
To the pathology we are considering, there is a relation J 96, by which we mean respiratory insufficiency. Septic shock also refers to a disease such as multiple organ dysfunction (ICD-10 code, A 41.9 "Septimization, unspecified").
Thus, having the International Classification of Diseases at hand, one can obtain the necessary information regarding the established diagnosis.
Prevent stress-reaction of the body is possible. For this, it is necessary to undergo timely diagnosis in order to prevent the transition of severe pathology or any other disease into a critical stage. This is actually a key technique by which it is possible to stop the development of multiple organ failure.
For successful implementation of such a prophylactic scheme, functional evaluation and monitoring are necessary, followed by normalization of blood circulation, elimination of infection, energy supply, normalization of metabolism and respiration, as well as early treatment of inflammation, trauma and necrosis.
Methods of treatment
When neutralizing such a complex problem as multi-organ failure, correct step-by-step actions are important. It is about the artificial replacement or maintenance of systems, the violation of which can lead to death. In most cases, it is the circulatory and respiratory system.
Next, it is necessary to conduct a semi-functional study, with which you need to determine the extent of damage to organs and systems. The next step is to strengthen the correction of physiological mechanisms. Then the affected systems are treated and withdrawn from the critical state.
Another method that allows to influence the multi-organ failure is the anti-mediator effect. In other words, it is necessary to block the receptors of endothelial cells.
An important element of the treatment system is the normalization of the energy balance, which is understood as the creation of acid-base balance, metabolic correction, mixed, enteral and parenteral nutrition, the introduction of amino acids and vitamins necessary to bring the enzyme activity back to normal.
Do not neglect and adequate supply of oxygen to tissues through the normalization of microcirculation and lung function.
The development of multiple organ failure is too great a risk to human life. There is no guarantee that when systems of the body, like the bodies themselves, will begin to shut down, doctors will be able to reverse the destructive process and save the patient. Therefore, in case of serious injuries and developing infections must, without delay, to go to the doctor and undergo treatment.
To prevent multiple organ failure is much easier and cheaper than treating a progressive disease.