Pathogenesis and treatment of multiorgan failure dysfunction syndrome in shock

Pathogenesis and treatment of multiorgan dysfunction syndrome (MODS) have been presented, basing on literature and own experience. The term multiple organ dysfunction syndrome--MODS is now regarded to be the most accurate. The classification and the pathogenesis of primary and secondary MODS are discussed. In the primary MODS causes are to be looked for in the extensive injuries of tissues, hypoxia and the ischemia-reperfusion syndrome. In the secondary MODS, because of the effects of other deteriorative factors, the systemic infection response syndrome (SIRS) appears. The course of this reaction has been discussed, pointing the attention to the effects of proinflammatory cytokins (mainly TNF alpha), then to the role of neutrophils and the intestinal translocation. Various approaches to the prevention and treatment of MODS are presented. In the primary MODS very important is an appropriate tissue perfusion restoration and elimination of necrotic tissue. In the secondary MODS there are new ways of treatment. Used are: monoclonal antibodies, antioxidants, inhibitors of cytokins and proteases, hemofiltration, selective bowel decontamination. Enteral nutrition, if possible--provides not only the supply of food substrates but it may also inhibit cytokin release, decrease translocation and improves hemodynamics. The prognosis in MODS is still very serious, however, its improvement is to be regarded after the application of new therapeutic methods.