What is the role of pulmonary dysfunction in the staging of multiple organ dysfunction syndrome (MODS) in sepsis?

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

There are two well-defined forms of multiple organ dysfunction syndrome (MODS). In both, the development of acute lung injury (ALI) or ARDS is of key importance to the natural history. ARDS is the earliest manifestation in all cases (see the images below).

Acute respiratory distress syndrome (ARDS) present Acute respiratory distress syndrome (ARDS) present in this chest x-ray (CXR) film is a common organ system affected in multiorgan failure of sepsis.
Acute respiratory distress syndrome (ARDS) shown i Acute respiratory distress syndrome (ARDS) shown in this chest x-ray (CXR) film is a common complication of septic shock. Note bilateral airspace infiltration, absence of cardiomegaly, vascular redistribution, and Kerley B lines.
Organizing phase of diffuse alveolar damage (ARDS) Organizing phase of diffuse alveolar damage (ARDS) secondary to septic shock shows diffuse alveolar injury and infiltration with inflammatory cells.
Organizing diffuse alveolar damage in a different Organizing diffuse alveolar damage in a different location showing disorganization of pulmonary architecture.
A high-power view of organizing diffuse alveolar d A high-power view of organizing diffuse alveolar damage (ARDS) shows hyperplasia of type II pneumocytes and hyaline membrane deposits.

In the more common form of MODS, the lungs are the predominant—and often the only—organ system affected until very late in the disease. These patients most often present with a primary pulmonary disorder, such as pneumonia, aspiration, contusion, near drowning, exacerbation of chronic obstructive pulmonary disease (COPD), hemorrhage, or pulmonary embolism.


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