What should be included in long-term monitoring of patients with 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

The major focus of resuscitation from septic shock is supporting cardiac and respiratory functions. To prevent MODS, these patients require a very close monitoring and institution of appropriate therapy for major organ function. Problems encountered in these patients include the following:

  • Temperature control – Fever generally requires no treatment, except in patients with limited cardiovascular reserve, because of increased metabolic requirements; antipyretic drugs and physical cooling methods, such as sponging or cooling blankets, may be used to lower the temperature

  • Metabolic support – Patients with septic shock develop hyperglycemia and electrolyte abnormalities; serum glucose should be kept in normal range with insulin infusion; regular measurement and correction of electrolyte deficiency (including hypokalemia, hypomagnesemia, hypocalcemia and hypophosphatemia) is recommended

  • Anemia and coagulopathy – Hemoglobin as low as 7 g/dL is well tolerated and does not warrant transfusion unless the patient has poor cardiac reserve or demonstrates evidence of myocardial ischemia; thrombocytopenia and coagulopathy are common in sepsis and do not necessitate replacement with platelets or fresh frozen plasma, unless the patient develops active clinical bleeding

  • Renal dysfunction – Closely monitor urine output and renal function in all patients with sepsis; any abnormalities of renal function should prompt attention to adequacy of circulating blood volume, cardiac output, and blood pressure; correct these if they are inadequate

  • Nutritional support – Early nutritional support is of critical importance in patients with septic shock; the enteral route is preferred unless the patient has an ileus or other abnormality; gastroparesis is observed commonly and can be treated with motility agents or placement of a small bowel feeding tube

For patients who survive sepsis and MODS, the road to recovery is often long and challenging. Post hospital discharge, patients may have physical, emotional, and cognitive consequences. In addition, these patients have a higher risk of repeat sepsis episodes. Aggressive rehabilitation programs, including psychological treatments, may be helpful. [28]


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