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Pediatric Multiple Organ Dysfunction Syndrome: Promising Therapies
Allan Doctor1, Jerry Zimmerman, Michael Agus
11Departments of Pediatrics (Critical Care Medicine) and Biochemistry, Washington University in St. Louis, St. Louis, MO. 2Department of Pediatrics (Critical Care Medicine), University of Washington, Seattle, WA. 3Department of Pediatrics (Critical Care Medicine), Harvard University, Boston, MA. 4Department of Pediatrics (Critical Care Medicine), Michigan State University, Grand Rapids, MI. 5Departments of Pediatrics (Critical Care Medicine) and Microbiology, University of Chicago, Chicago, IL. 6Department of Pediatrics (Critical Care Medicine), Emory University, Atlanta, GA. 7Obstetric and Pediatric Pharmacology and Therapeutics Branch, NICHD, Bethesda, MD. 8Department of Pediatrics (Critical Care Medicine), University of Arizona, Phoenix, AZ.
Insights
Pediatric multiple organ dysfunction syndrome (MODS) is common and deadly. Discovering and evaluating effective therapies, including novel treatments and optimized supportive care, is crucial for improving outcomes in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Pediatric intensive care
- Pediatric organ dysfunction
Background:
- Multiple organ dysfunction syndrome (MODS) is a frequent and severe complication in critically ill children.
- MODS is associated with substantial morbidity and mortality rates.
- Current therapeutic strategies for pediatric MODS require significant advancement.
Purpose of the Study:
- To review the current scientific understanding of pediatric MODS.
- To identify knowledge gaps in the diagnosis and treatment of pediatric MODS.
- To propose future research directions for promising therapies.
Main Methods:
- A workshop involving experts in pediatric critical care.
- Literature review, research data synthesis, and expert opinion.
- Discussion and debate focused on identifying research priorities.
Main Results:
- Summary of presentations on MODS, supported by existing literature.
- Identified key areas for improving care: pharmacokinetics/pharmacodynamics, nutrition, and glucose control.
- Highlighted promising therapies: extracorporeal, anticytokine, antitoxin, antioxidant, and steroid treatments.
Conclusions:
- Effective therapies for pediatric MODS are needed and must be rigorously evaluated.
- Further research into pharmacokinetics, nutrition, and glucose management is essential.
- Advancement in pediatric MODS requires systematic assessment and implementation of novel therapeutic approaches.
Objective:
To describe the state of the science, identify knowledge gaps, and offer potential future research questions regarding promising therapies for children with multiple organ dysfunction syndrome presented during the Eunice Kennedy Shriver National Institute of Child Health and Human Development Workshop on Pediatric Multiple Organ Dysfunction Syndrome (March 26-27, 2015).
Data Sources:
Literature review, research data, and expert opinion.
Study Selection:
Not applicable.
Data Extraction:
Moderated by an expert from the field, issues relevant to the association of multiple organ dysfunction syndrome with a variety of conditions were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.
Data Synthesis:
Summary of presentations and discussion supported and supplemented by relevant literature.
Conclusions:
Among critically ill children, multiple organ dysfunction syndrome is relatively common and associated with significant morbidity and mortality. For outcomes to improve, effective therapies aimed at preventing and treating this condition must be discovered and rigorously evaluated. In this article, a number of potential opportunities to enhance current care are highlighted including the need for a better understanding of the pharmacokinetics and pharmacodynamics of medications, the effect of early and optimized nutrition, and the impact of effective glucose control in the setting of multiple organ dysfunction syndrome. Additionally, a handful of the promising therapies either currently being implemented or developed are described. These include extracorporeal therapies, anticytokine therapies, antitoxin treatments, antioxidant approaches, and multiple forms of exogenous steroids. For the field to advance, promising therapies and other therapies must be assessed in rigorous manner and implemented accordingly.
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