Which procedures are performed for monitoring of suspected multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Procedures such as cardiac monitoring, noninvasive blood pressure monitoring, and pulse oximetry are necessary because patients often require admission to the intensive care unit (ICU) for invasive monitoring and support. Supplemental oxygen is provided during initial stabilization and resuscitation.

In all patients in septic shock, adequate venous access for volume resuscitation is necessary. A central venous line can also be used to monitor central venous pressure for assessment of intravascular volume status.

An indwelling urinary catheter used to monitor urinary output can serve as a marker for adequate renal perfusion and cardiac output.

Patients in whom septic shock associated with acute lung injury or right-sided heart failure require either right-heart catheterization with a pulmonary artery (Swan-Ganz) catheter or a transpulmonary thermodilution device (eg, PiCCO, Vigileo) to guide therapy. These catheters provide an assessment of the volume status of a patient who is in a septic state. Cardiac output measurements can be obtained. Furthermore, determination of mixed venous oxygenation from the pulmonary artery catheter is helpful in determining the status of tissue oxygenation.

Dynamic hemodynamic monitoring devices using pulse pressure and stroke volume variation are used in some centers when the patients are in sinus rhythm and on mechanical ventilation without spontaneous breathing to define volume responsiveness and assess dynamic arterial tone, both useful in deciding on resuscitation treatment options.


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