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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

 

 
 

Last updated: 05 January 2008

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