Multiple organ failure

Circulatory failure

  • Criteria for diagnosis

    • Bradycardia (heart rate <50 bpm)

    • Hypotension (mean arterial pressure <50 mmHg)

    • Ventricular tachycardia or fibrillation

    • Metabolic acidosis (pH <7.2)

  • Management

    • Optimise cardiac preload

    • Maximise cardiac contractility with inotropes

    • Maximise perfusion pressures with vasopressors

    • Correct anaemia

    • Treat arrhythmia

Respiratory failure

  • Criteria for diagnosis

    • Respiratory rate <5 or >40 breaths  per minute

    • Hypercapnia (PaCO2 > 6.7 kPa)

    • Hypoxaemia

  • Management

    • Oxygen

    • Mechanical ventilation

    • PEEP or CPAP

    • Extra or intracorporeal gas exchange

Acute renal failure

  • Criteria for diagnosis

    • Urine output < 400 ml per 24 hours

    • Serum creatinine > 150 mmol/l

  • Management

    • Conservative measures

    • Fluid and potassium restriction

    • Drug dose adjustment

    • Haemofiltration of dialysis

Haematological failure

  • Criteria for diagnosis

    • Leucopenia (WCC < 1000 cell / mm3)

    • Thrombocytopenia (platelet < 20,000 / mm3)

    • Evidence of disseminated intravascular coagulation

  • Management

    • Red cell and platelet transfusion

    • Fresh frozen plasma

    • Correct antithrombin III deficiency

Hepatic failure

  • Criteria for diagnosis

    • Coagulation defect

    • Rising hepatic enzymes

  • Management

    • Fresh frozen plasma

    • Nutritional support

    • Correct hypoalbuminaemia

Gastrointestinal failure

  • Criteria for diagnosis

    • Ileus

    • Gastroparesis

    • Haemorrhage

  • Management

    • Parenteral nutrition

    • Stress ulcer prophylaxis

    • Selective gastrointestinal decontamination

Neurological failure

  • Criteria for diagnosis

    • Depressed level of consciousness (Glasgow coma score <6)

    • Fits

  • Management

    • Oxygenation

    • Control seizures
 
 

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