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Specific Etiologies Associated With the Multiple Organ Dysfunction Syndrome in Children: Part 1

Upperman, Jeffrey S. MD; Lacroix, Jacques MD; Curley, Martha A. Q. RN, PhD, FAAN; Checchia, Paul A. MD, FCCM, FACC; Lee, Daniel W. MD; Cooke, Kenneth R. MD; Tamburro, Robert F. MD, MSc

doi: 10.1097/PCC.0000000000001048
MODS Supplement

Objective: To describe a number of the conditions associated with multiple organ dysfunction syndrome presented as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development multiple organ dysfunction syndrome workshop (March 26–27, 2015).

Data Sources: Literature review, research data, and expert opinion.

Study Selection: Not applicable.

Data Extraction: Moderated by an expert from the field, issues relevant to the association of multiple organ dysfunction syndrome with a variety of conditions were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data Synthesis: Summary of presentations and discussion supported and supplemented by the relevant literature.

Conclusions: There is a wide range of medical conditions associated with multiple organ dysfunction syndrome in children. Traditionally, sepsis and trauma are the two conditions most commonly associated with multiple organ dysfunction syndrome both in children and adults. However, there are a number of other pathophysiologic processes that may result in multiple organ dysfunction syndrome. In this article, we discuss conditions such as cancer, congenital heart disease, and acute respiratory distress syndrome. In addition, the relationship between multiple organ dysfunction syndrome and clinical therapies such as hematopoietic stem cell transplantation and cardiopulmonary bypass is also considered. The purpose of this article is to describe the association of multiple organ dysfunction syndrome with a variety of conditions in an attempt to identify similarities, differences, and opportunities for therapeutic intervention.

1Division of Pediatric Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA.

2Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada.

3School of Nursing, Departments of Anesthesia and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA.

4Sections of Critical Care and Cardiology, Department of Pediatrics, Baylor College of Medicine Texas Children’s Hospital, Houston, TX.

5Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Virginia, Charlottesville, VA.

6Department of Oncology, Pediatric Blood and Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD.

7Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD.

This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, the National Institutes of Health, the U.S. Department of Health and Human Services, or the U.S. government.

Drs. Upperman, Curley, and Lee received support for this article research from the National Institutes of Health (NIH). Dr. Curley’s institution received funding from National Heart, Lung, and Blood Institute and the National Institute of Nursing Research, NIH (grant U01 HL086622). Dr. Lee also received support from the St. Baldrick’s Foundation Scholar Award with generous support from the Hope From Harper Fund. Dr. Cooke received funding from the NIH (R01 HL111682 and R01 HD074587) and received funding from Jazz pharmaceuticals, advisory board (money paid had no influence on my efforts for this study). Dr. Tamburro’s former institution received funding from the U.S. Food and Drug Administration Office of Orphan Product Development Grant Program and from Ony, LLC (provided the calfactant free of charge for the above grant, which assessed the efficacy of surfactant in pediatric hematopoietic stem cell transplant patients with acute lung injury). He received funding from Springer Publishing. Dr. Tamburro disclosed government work, and he disclosed off-label/unapproved drugs or products: serum interleukin (IL)-6 levels in responding patients have been measured to be greater than 3,000 pg/mL (normal < 10 pg/mL), and the fever and hemodynamic instability reported in cytokine release syndrome (CRS) can be reversed within hours of the administration of the anti–IL-6 receptor monoclonal antibody, tocilizumab. Clinical experience suggests that the timely administration of tocilizumab with or without corticosteroids to the patient with moderate-grade CRS is of paramount importance in preventing severe, life-threatening CRS characterized by multiple organ dysfunction although this has not been confirmed in phase II or III trial. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies