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The pediatric multiple organ dysfunction syndrome

Proulx, François MD; Joyal, Jean Sébastien MD; Mariscalco, M Michele MD; Leteurtre, Stéphane MD; Leclerc, Francis MD; Lacroix, Jacques MD

Pediatric Critical Care Medicine: January 2009 - Volume 10 - Issue 1 - p 12-22
doi: 10.1097/PCC.0b013e31819370a9
Invited Review Articles

Objectives: To review the epidemiology of pediatric multiple organ dysfunction syndrome (MODS) and summarize current concepts regarding the pathophysiology of shock, organ dysfunction, and nosocomial infections in this population.

Data Source: A MEDLINE-based literature search using the keywords MODS and child, without any restriction to the idiom.

Main Results: Critically ill children may frequently develop multisystemic manifestations during the course of severe infections, multiple trauma, surgery for congenital heart defects, or transplantations. Descriptive scores to estimate the severity of pediatric MODS have been validated. Young age and chronic health conditions have also been recognized as important contributors to the development of MODS. Unbalanced inflammatory processes and activation of coagulation may lead to the development of capillary leak and acute respiratory distress syndrome. Neuroendocrine and metabolic responses may result in insufficient adaptive immune response and the development of nosocomial infections, which may further threaten host homeostasis.

Conclusions: Over the last 20 yrs, there has been an increasing knowledge on the epidemiology of pediatric MODS and on the physiologic mechanisms involved in the genesis of organ dysfunction. Nevertheless, further studies are needed to more clearly evaluate what is the long-term outcome of pediatric MODS.

From the Division of Critical Care Medicine (FP, JSJ, JL), Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Canada; Department of Pediatrics (MMM), Section of Critical Care Medicine, Baylor College of Medicine, Houston, TX; and Department of Pediatrics (SL, FL), Service de Réanimation Pédiatrique, Hôpital Jeanne de Flandre, Lille, France.

The authors have not disclosed any potential conflicts of interest.

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©2009The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies