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Gastroenterology May 2019Acute pancreatitis may be associated with both local and systemic complications. Systemic injury manifests in the form of organ failure, which is seen in approximately... (Review)
Review
Acute pancreatitis may be associated with both local and systemic complications. Systemic injury manifests in the form of organ failure, which is seen in approximately 20% of all cases of acute pancreatitis and defines "severe acute pancreatitis." Organ failure typically develops early in the course of acute pancreatitis, but also may develop later due to infected pancreatic necrosis-induced sepsis. Organ failure is the most important determinant of outcome in acute pancreatitis. We review here the current understanding of the risk factors, pathophysiology, timing, impact on outcome, and therapy of organ failure in acute pancreatitis. As we discuss the pathophysiology of severe systemic injury, the distinctions between markers and mediators of severity are highlighted based on evidence supporting their causality in organ failure. Emphasis is placed on clinically relevant end points of organ failure and the mechanisms underlying the pathophysiological perturbations, which offer insight into potential therapeutic targets to treat.
Topics: Acute Disease; Animals; Humans; Multiple Organ Failure; Pancreatitis; Prognosis; Risk Assessment; Risk Factors
PubMed: 30768987
DOI: 10.1053/j.gastro.2018.12.041 -
Clinics in Chest Medicine Dec 1990Diagnostic criteria for individual organ system failure are imprecise, a factor that adds a considerable amount of ambiguity to this area of clinical research.... (Review)
Review
Diagnostic criteria for individual organ system failure are imprecise, a factor that adds a considerable amount of ambiguity to this area of clinical research. Nonetheless, multiple organ failure is a common sequela of ARDS and other catastrophic medical and surgical illnesses that continues to limit patient survival. The cumulative weight of investigative evidence currently supports the premise that concepts of acute respiratory failure must encompass the abnormal gas exchange in the systemic as well as the pulmonary microvasculature. In this context, we need not dispense with the term ARDS, as respiratory distress applies equally to the nonpulmonary organs as well as the lungs.
Topics: Bacterial Infections; Hemodynamics; Humans; Multiple Organ Failure; Respiratory Distress Syndrome
PubMed: 2268991
DOI: No ID Found -
Intensive Care Medicine Jul 1996
The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.
Topics: Humans; Multiple Organ Failure; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Time Factors
PubMed: 8844239
DOI: 10.1007/BF01709751 -
Advances in Surgery 1993
Review
Topics: Bacterial Infections; Humans; Multiple Organ Failure; Nutritional Physiological Phenomena; Oxygen Consumption
PubMed: 8418569
DOI: No ID Found -
Disease-a-month : DM Dec 1992Tissue injury, whether from infection, blood or volume loss, trauma, or inflammation such as pancreatitis, induces local and systemic responses. The systemic responses... (Review)
Review
Tissue injury, whether from infection, blood or volume loss, trauma, or inflammation such as pancreatitis, induces local and systemic responses. The systemic responses include shock, reperfusion, systemic inflammation (hypermetabolism) with primary organ dysfunction, and secondary organ dysfunction that either becomes progressive and leads to death or from which the patient recovers and enters into a period of prolonged rehabilitation. Each of these responses has its pathogenesis and treatments that are appropriate and effective. The research indicates that the responses may contribute to the development of cell and organ injury and to progressive multiple organ failure syndrome and death, particularly in the case of the systemic inflammatory response. Current therapy is designed to rapidly remove the cause of injury, resuscitate the microcirculation, and institute nutrition therapy to prevent single and generalized nutrient deficiencies and promote repair and healing. Newer therapies are designed to modulate the inflammatory response itself to minimize its injury potential and promote tissue repair and recovery of the patient. Genetic regulation of metabolism is also a pathogenetic mechanism. Its role in these responses is just starting to be understood--new therapies will need to await this understanding. Once the patient begins to recover, rehabilitation tends to be long and problematic. Nonetheless, significant survival rates are now occurring, with continued improvements expected in response to the newer therapeutic approaches. Planned rehabilitation thus becomes an important component of effective recovery. Professionals trained in critical care and well versed in cellular and molecular biology provide the milieu within which continued improvements in prevention, therapy, and outcome will continue to occur.
Topics: Combined Modality Therapy; Critical Care; Cross Infection; Humans; Multiple Organ Failure; Resuscitation
PubMed: 1478149
DOI: 10.1016/0011-5029(92)90012-e -
Annals of Medicine Feb 1995The management of the surgical patient with multiple system organ failure remains a formidable problem. Despite advances in critical care, the mortality of multiple... (Review)
Review
The management of the surgical patient with multiple system organ failure remains a formidable problem. Despite advances in critical care, the mortality of multiple organ failure remains unchanged since the syndrome was characterized almost two decades ago. At the present time there are no modalities that can actively reverse established organ failure, hence the treatment of these patients consists of metabolic and haemodynamic support until the process reverses itself or death occurs. Therefore, the best management of the surgical patient at risk for multiple organ failure is prevention of the syndrome. Strategies to avoid organ failure include early fixation of long bone fractures, prompt restoration of perfusion and oxygen delivery, the aggressive diagnosis and drainage of abdominal infection prior to organ failure, early institution of enteral nutrition and the use of specific nutritional substrates and formulas. This review will examine the current theories in the pathogenesis of multiple organ failure and detail two clinical decisions, early stabilization of fractures and prompt re-exploration for suspected abdominal sepsis, that have been associated with a reduction in the frequency of the development of organ failure.
Topics: Humans; Intensive Care Units; Multiple Organ Failure; Surgical Procedures, Operative
PubMed: 7741992
DOI: 10.3109/07853899509031931 -
Pediatric Clinics of North America Jun 2022Acute liver failure (ALF) in children, irrespective of cause, is a rapidly evolving catastrophic clinical condition that results in high mortality and morbidity without... (Review)
Review
Acute liver failure (ALF) in children, irrespective of cause, is a rapidly evolving catastrophic clinical condition that results in high mortality and morbidity without prompt identification and intervention. Massive hepatocyte necrosis impairs the synthetic, excretory, and detoxification abilities of the liver, with resultant coagulopathy, jaundice, metabolic disturbance, and encephalopathy. Extrahepatic organ damage, multiorgan failure, and death result from circulating inflammatory mediators released by the hepatocytes undergoing necrosis. There are yet no treatment options available for reversing or halting hepatocellular necrosis, thus current therapy focuses on supporting failing organs and preventing life threatening complications pending either spontaneous liver recovery or transplantation. The aims of this review are to define pediatric acute liver failure (PALF), understand the pathophysiologic processes that lead to multiorgan failure, to describe the consequences of a failing liver on extrahepatic organs, to enumerate the critical care challenges encountered during PALF management, and to describe pharmacologic and extracorporeal options available to support a critically ill child with ALF in the intensive care unit.
Topics: Child; Humans; Liver Failure, Acute; Liver Transplantation; Multiple Organ Failure; Necrosis
PubMed: 35667757
DOI: 10.1016/j.pcl.2022.02.003 -
Shock (Augusta, Ga.) Dec 1994Multiple organ failure, multiple organ dysfunction syndrome, and the systemic inflammatory response syndrome are problems of medical progress and intensive care units... (Review)
Review
Multiple organ failure, multiple organ dysfunction syndrome, and the systemic inflammatory response syndrome are problems of medical progress and intensive care units (ICUs) and require prevention of organ failure through excellent patient care. New concepts in prevention include: 1) the need to improve microcirculatory blood flow (Mbf) early after injury or illness, 2) stopping or controlling injury or infection by early definitive operation when necessary, 3) a zero defect operation is necessary, 4) necrotic tissue and an overwhelming inflammatory burden are problems and should be lessened when possible, 5) adequate resuscitation to improve Do2, Vo2, and organ blood flow is necessary, 6) supporting metabolism and the GI tract may decrease complications of injury and sepsis, 7) support of host defense and/or immunomodulation to decrease the incidence of sepsis, and 8) treating the patient and the illness or injury, not just the mediators. Experimental evidence in animals and human volunteers for concepts, mechanisms, and treatment of injury or illness can be substantial and persuasive, but it may be difficult to demonstrate efficacy in sick patients. Clinical situations are variable and complex. It is difficult to dissect out, identify, and control or block a single factor or mediator. All biologic processes require a level of activity that can be hazardous in excess but dangerous if decreased or eliminated. Stimulation of our natural defense or control mechanisms of inflammation, replacement of lost or decreased factors, and better understanding of the interrelationships and mechanisms of inflammation will contribute to therapy. Whether blockade of mediators or treatment of the manifestations of diseases or injuries will have substantial impact remains to be learned. A single magic bullet for complex and diverse illnesses is not likely to appear or to be successful. In this review it was not possible to describe many of the observations and recommendations in this immense and complex field. I apologize to those whose work I have inadvertently not included.
Topics: Humans; Infection Control; Inflammation; Multiple Organ Failure; Resuscitation; Risk Factors; Syndrome; Terminology as Topic
PubMed: 7743367
DOI: 10.1097/00024382-199412000-00001 -
Pediatric Clinics of North America Oct 2017Adjunctive therapies have been proposed for use in at least 5 inflammation pathobiology phenotypes in pediatric sepsis-induced multiple organ failure. This article... (Review)
Review
Adjunctive therapies have been proposed for use in at least 5 inflammation pathobiology phenotypes in pediatric sepsis-induced multiple organ failure. This article discusses host-pathogen interaction prototypes to facilitate understanding of the rationale for personalized therapy in these phenotypes. The article discusses the literature on adjunctive antiinflammatory and immune modulation therapies that, in addition to traditional organ support and infection source control, might be part of a personalized precision medicine approach to the reversal of each of these inflammatory pathobiology phenotypes.
Topics: Child; Combined Modality Therapy; Critical Care; Humans; Multiple Organ Failure; Precision Medicine; Sepsis
PubMed: 28941536
DOI: 10.1016/j.pcl.2017.06.007 -
Infection Aug 2021Significant conflicts regarding prophylactic antifungal treatment in acute pancreatitis (AP) exist among current literatures and guidelines. The key to resolving this...
PURPOSE
Significant conflicts regarding prophylactic antifungal treatment in acute pancreatitis (AP) exist among current literatures and guidelines. The key to resolving this controversial issue is to identify risk factors for intra-abdominal fungal infection (AFI) among patients with AP.
METHODS
A single-center, retrospective cohort of 826 patients with AP between January 2014 to December 2019 was analysed to study the risk factors of AFI.
RESULTS
Of the 826 patients with AP, 10 patients (1.2%) developed AFI, including 2 cases in moderately severe AP (MSAP) and 8 in severe AP (SAP). The incidence of AFI was significantly higher in patients with SAP compared with MSAP and mild AP (10.3 vs. 0.8% vs. 0, P < 0.001). SAP patients with AFI were more likely to have multiple organ failure (MOF) (OR = 13.4; 95% CI 1.6-115.5), organ failure lasting more than 1 week (OR = 5.1; 95% CI 1.0-27.0), and surgical intervention within first week of admission (OR = 7.4; 95% CI 1.0-53.6). Multivariable analysis identified MOF (OR = 14.3; 95% CI 1.2-173.8) as the only independent risk factor of AFI.
CONCLUSION
MOF might be the indication of prophylactic antifungal therapy in patients with AP.
Topics: Acute Disease; Antifungal Agents; Humans; Multiple Organ Failure; Pancreatitis; Retrospective Studies; Severity of Illness Index
PubMed: 33988828
DOI: 10.1007/s15010-021-01625-6