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Multiple organ dysfunction during resuscitation is not postinjury multiple organ failure
David J Ciesla1, Ernest E Moore, Jeffrey L Johnson
1Denver Health Medical Center and the University of Colorado Health Sciences Center, USA. david.ciesla@dhha.org
Archives of Surgery (Chicago, Ill. : 1960)
|June 16, 2004
Summary
Multiple organ dysfunction (MOD) is a reversible response to severe injury and resuscitation. Many patients experiencing MOD within 48 hours of trauma show resolution, indicating a dynamic physiologic process.
Area of Science:
- Trauma critical care
- Physiology of injury response
- Organ dysfunction syndromes
Background:
- Multiple organ dysfunction (MOD) is a significant concern in trauma care.
- Understanding the early dynamics of MOD is crucial for patient outcomes.
Purpose of the Study:
- To investigate the incidence and reversibility of early post-injury MOD.
- To characterize patients who develop MOD and subsequent multiple organ failure (MOF).
Main Methods:
- Prospective 10-year inception cohort study of 1,277 trauma patients.
- Inclusion criteria: age ≥16, ICU admission, ISS >15, survival >48 hours; exclusion: isolated head injuries.
- MOD defined as Denver MOF score ≥4 within 48 hours; MOF defined as Denver MOF score ≥4 after 48 hours.
Main Results:
- MOD occurred in 16% (n=209) and MOF in 23% (n=300) of patients.
- Higher age, ISS, and 12-hour transfusion needs were associated with MOD/MOF.
- Of those with MOD, 64% progressed to MOF, while 36% resolved within 48 hours.
Conclusions:
- Early MOD following severe injury is often a reversible physiologic response.
- Resolution of MOD during resuscitation suggests a dynamic recovery process in a subset of patients.