NUR 314 Exam 1 - SIRS (Systemic Inflammatory Response Syndrome) and MODS (Multiple Organ Dysfunction Syndrome)

Relationship of shock, SIRS, and MODS

Systemic inflammatory response syndrome (SIRS)

• A systemic inflammatory response to a variety of insults

• Generalized inflammation in organs remote from the initial insult

SIRS triggers

• Mechanical tissue trauma: burns, crush injuries, surgery

• Abscess formation: intraabdominal, extremities

• Ischemic or necrotic tissue: pancreatitis, vascular disease, MI

• Microbial invasion: bacteria, viruses, fungi

• Endotoxin release: gram-negative and gram-positive bacteria

• Global perfusion deficits: postcardiac resuscitation, shock states

• Regional perfusion deficits: distal perfusion deficits

Multiple organ dysfunction syndrome (MODS)

• A failure of 2 or more organ systems

• Homeostasis cannot be maintained without intervention

• Results from SIRS

SIRS and MODS - consequences of inflammatory response

• Release of mediators

• Direct damage to endothelium

• Hypermetabolism

  • Extreme weight loss/wasting away

• Increase in vascular permeability

• Activation of coagulation cascade

SIRS and MODS - organ and metabolic dysfunction

• Hypotension

• Decreased perfusion

  • Know S and S of decreased perfusion

    • Cold/pale/blue skin, numbness/tingling, cramping/pain in limbs during activity, slow-healing sores, swelling, weak nails/hair, and sometimes chest pain or erectile dysfunction

• Formation of micro-emboli

• Redistribution or shunting of blood

SIRS and MODS - respiratory system

• Alveolar edema

• Decrease in surfactant

• Increase in shunt

• V/Q mismatch

• End result: ARDS

SIRS and MODS - cardiovascular system

• Myocardial depression and massive vasodilation

  • Results in decreased SVR and BP

• Baroreceptors respond to enhance CO

• Albumin and fluid move out of blood vessels

• Increased CVP and PAWP

SIRS and MODS - neurologic system

• Mental status changes due to hypoxemia, inflammatory mediators, or impaired perfusion

• Often early sign of MODS

• Confusion, agitation, combative, lethargy

SIRS and MODS - renal system

Acute kidney injury (AKI)

• Hypoperfusion

• Release of mediators

• Activation of renin-angiotensin-aldosterone system

• Nephrotoxic drugs, especially antibiotics

SIRS and MODS - GI system

• Motility decreased: abdominal distention and paralytic ileus

• Decreased perfusion: increased risk for ulceration and GI bleeding

• Potential for bacterial translocation

SIRS and MODS - hypermetabolic state

• Hyperglycemia-hypoglycemia

• Insulin resistance

• Catabolic state

• Liver dysfunction

• Lactic acidosis

SIRS and MODS manifestations

• Disseminated intravascular coagulation (DIC) from dysfunction of coagulation system

• Electrolyte imbalances

• Metabolic acidosis

SIRS and MODS goal

• Prognosis for MODS is poor

• Goal: prevent the progression of SIRS to MODS

• Vigilant assessment and ongoing monitoring to detect early signs of deterioration or organ dysfunction are critical

Care for patients with MODS focuses on

• Preventing and treating infection

• Maintaining tissue oxygenation

• Nutrition and metabolic support

• Appropriate support of individual failing organs

SIRS and MODS infection prevention and treatment

Aggressive infection control strategies to decrease risk for hospital acquired infection

• Strict asepsis

• Assess need for invasive lines

• Aggressive surgery to remove necrotic tissue

• Aggressive pulmonary management

• Early mobilization

SIRS and MODS oxygenation

Decrease O2 demand and increased O2 delivery

• Sedation

• Mechanical ventilation

• Analgesia

• Rest

• Treat fever, chills, and pain

SIRS and MODS nutrition and metabolic needs

• Goal of nutrition support: preserve organ function

• Total energy expenditure is often increased 1.5 to 2.0 times

• Use of EN is preferred to parenteral nutrition

• Monitor plasma transferrin and prealbumin levels to assess hepatic protein synthesis

• Provide glycemic control

SIRS and MODS interprofessional care

• Support of failing organs

  • ARDS: aggressive O2 therapy and mechanical ventilation

  • DIC: appropriate blood products

  • Renal failure: continuous renal replacement therapy or dialysis

• Consider that further interventions may be futile

  • Communicate with caregiver about realistic goals and outcomes