SIRS AND MODS

SIRS
Systemic inflammatory response syndrome (SIRS) is 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, surgical procedures Abscess formation: intraabdominal, extremities Ischemic or necrotic tissue: pancreatitis, vascular disease, myocardial infarction

SIRS
Triggers
Microbial invasion: bacteria, viruses, fungi Endotoxin release: gram-negative bacteria Global perfusion deficits: post cardiac resuscitation, shock states Regional perfusion deficits: distal perfusion deficits

MODS
Multiple organ dysfunction syndrome (MODS) is the failure of two or more organ systems.
Homeostasis cannot be maintained without intervention. Results from SIRS Mortality rates are linearly related to the number of failed organ systems

MODS
Stage 1
Increased volume requirements Mild respiratory alkalosis which is accompanied by oliguria, hyperglycemia and insulin requirements.

Stage 2
Tachypneic, hypocapnic and hypoxemic. Moderate liver dysfunction Possible hematologic abnormalities.

Stage 3
Shock with BUN/creatine, acid-base disturbances. Significant coagulation abnormalities.

Stage 4
Vasopressor dependent and UO. Ischemic colitis and lactic acidosis follow.
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RELATIONSHIP OF SHOCK, SIRS, AND MODS

SIRS AND MODS PATHOPHYSIOLOGY

Consequences of inflammatory response
Release of mediators Direct damage to the endothelium Hypermetabolism Vasodilation leading to decreased SVR Increase in vascular permeability Activation of coagulation cascade

SIRS AND MODS PATHOPHYSIOLOGY

Organ and metabolic dysfunction
Hypotension Decreased perfusion Formation of microemboli Redistribution or shunting of blood

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SIRS AND MODS PATHOPHYSIOLOGY

Respiratory system
Alveolar edema Decrease in surfactant Increase in shunt V/Q mismatch End result: ARDS

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SIRS AND MODS PATHOPHYSIOLOGY

Cardiovascular system
Myocardial depression and massive vasodilation

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SIRS AND MODS PATHOPHYSIOLOGY

Neurologic system
Mental status changes due to hypoxemia, inflammatory mediators, or impaired perfusion Often early sign of MODS

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SIRS AND MODS PATHOPHYSIOLOGY

Renal system
Acute renal failure
Hypo-perfusion Release of mediators Activation of renin-angiotensin- aldosterone system Nephrotoxic drugs, especially antibiotics

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SIRS AND MODS PATHOPHYSIOLOGY

GI system
Motility decreased: abdominal distention and paralytic ileus Decreased perfusion: risk for ulceration and GI bleeding Potential for bacterial translocation

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SIRS AND MODS PATHOPHYSIOLOGY

Hypermetabolic state
Hyperglycemia-hypoglycemia Insulin resistance Catabolic state Liver dysfunction Lactic acidosis

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SIRS AND MODS PATHOPHYSIOLOGY

Hematologic system
DIC

Electrolyte imbalances Metabolic acidosis

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SIRS AND MODS COLLABORATIVE CARE

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.

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SIRS AND MODS COLLABORATIVE CARE

Prevention and treatment of infection
Aggressive infection control strategies to decrease risk for nosocomial infection Once an infection is suspected, institute interventions to control the source.

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SIRS AND MODS COLLABORATIVE CARE

Maintenance of tissue oxygenation
Decreased O2 demand
Sedation Mechanical ventilation Paralysis Analgesia

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SIRS AND MODS COLLABORATIVE CARE

Nutritional and metabolic needs
Goal of nutritional support: preserve organ function Total energy expenditure is often increased 1.5 to 2.0 times.

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SIRS AND MODS COLLABORATIVE CARE Nutritional and metabolic needs

Use of the enteral route is preferred to parenteral nutrition. Monitor plasma transferrin and prealbumin levels to assess hepatic protein synthesis.

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SIRS AND MODS COLLABORATIVE CARE

Support of failing organs
ARDS: aggressive O2 therapy and mechanical ventilation DIC: appropriate blood products Renal failure: continuous renal replacement therapy or dialysis

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SIRS AND MODS NURSING MANAGEMENT

Reduce chance of infection Dressing changes on all invasive line sites and surgical wounds according to protocol Maintain aseptic technique with all dressing changes and manipulation of intravenous lines. Institute the measures that are necessary to prevent aspiration when patients are placed on enteral feedings. Keep the head of the bed elevated, and check for residual volume and tube placement every 4 hours Oral care if on ventilator
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SIRS AND MODS NURSING MANAGEMENT

Provide frequent rest periods Create a quiet environment whenever possible. Schedule procedures and nursing care interventions so that the patient has periods of uninterrupted rest. Manage situations of increased metabolic demand such as fever, agitation, alcohol withdrawal, and pain promptly so that the patient conserves energy and limits oxygen consumption. Monitor bony prominences and areas of high risk for skin breakdown.

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