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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