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WSP - "Multiple Organ Dysfunction Syndrome" by Jacques Lacoix, MD, for OPENPediatrics

Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: [email protected] Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Welcome to the World Shared Practice Forum. I'm Dr. Jeff Burns, Chief of Critical Care at Boston Children's Hospital and Harvard Medical School. We're very pleased to have with us today Dr. Jacques Lacroix. Dr. Lacroix is Professor of Pediatrics at the University of Montreal and he is also on the faculty for Pediatric Critical Care Medicine at the Hospital St. Justine in Montreal, Canada. Jacques, welcome to the World Shared Practice Forum. And on behalf of my colleagues around the world, we acknowledge the wonderful research that you've done for decades now on transfusion medicine. And we also know that you've developed a research interest in multiple organ dysfunction syndrome. What is multiple organ dysfunction syndrome? Well the concept of multiple organ dysfunction, or MOD, if you want, appeared 40 years ago in 1975. And the idea was just because Dr. Baue and colleagues found in their surgical patients that some patients developed more and more organ dysfunctions, and that something was happening that was not only an addition of organ dysfunction, but something was going on. Over the years, by the way, many names have been used use for to describe multiple organ dysfunction syndrome, like multiple organ failure or even hypermetabolism failure complex and other names. But presently, I think there is a consensus to keep and use the name multiple organ dysfunction syndrome. So what it is, the definition presently of MODS is quite simple. There is a MODS in critically ill patients if we observe at the same time dysfunction of two organs, and up to seven organs are considered. There are a few lists of diagnostic criteria, we'll talk about that in a minute. But we are looking at respiratory, cardiovascular, neurological, hematological, renal, hepatic, and, in one case, gastrointestinal. I think the most important job was done first by Dr. Wilkinson in 1986, because they were the people who suggest some criteria for pediatric multiple organ dysfunction syndrome. But tens years later we felt that we must a little bit adapt that, so my colleague, Francois Proulx, suggests a new list. And in 2005, Dr. Goldstein, in symposium on sepsis and MODS brought up a new list of diagnostic criteria. So presently we have many lists of diagnostic criteria, and we'll discuss a bit later about the problem that can happen with those different lists. So I said to you MODS is not the only addition of organ system dysfunction, and it is characterized in typical MODS, well-blown MODS, you will find high blood levels of both pro- and anti-inflammatory agents. Which is strange, because usually in normal inflammation first you have a release of pro-inflammatory for a while. The anti-inflammatory comes in, stops the release of pro, and the inflammation stops this way. But in MODS, something happens that is wrong, and you will see at the same time very high levels of pro- and anti-inflammatory mediators. There are many other characteristics also that we can see in those patients. I will talk about physiopathogy a little later on. So if we look at MODS, MODS is indeed characterized by a consistent group of organ system and dysfunction. It is common in the ICU, it's at least 20% of all patients. The mechanism is not clearly delineated, but we know, as I told you, that there is a common denominator which is an uncontrolled inflammatory process. Some people talk about an inflammatory storm. Many conditions can cause MODS. An infection can cause MODS, and then we call that a sepsis. A trauma, hypoxia, shock, even intoxication can cause MODS. And by the way, MODS is closely associated with mortality. So it fills up very well the criteria for syndrome. We'd like to stop now and ask our colleagues around the world a question. In your answer, could you first please state your city and country location? And the question is this-- in your pediatric intensive care unit, what is the common inciting process that triggers multiple organ dysfunction syndrome? For example, infection, trauma, or unknown causes? We're back now with Dr. Jacques Lacroix.