Among the most feared complications that can occur during medical treatment is multiorgan failure. Only about half of affected patients survive when multiple organs, such as the kidneys, lungs, or heart, fail at the same time.
What is multiorgan failure?
The organs can be replaced by machines for a time if necessary. If the brain or liver are affected by the failure, the patient usually cannot be helped at all. To have any chance of survival at all in the event of multiple organ failure, it is essential that the patient receive intensive medical care. However, multiple organ failure often only occurs in the intensive care unit. There, however, it is usually recognized very quickly. Despite rapid countermeasures, this complication remains one of the most frequent causes of death in intensive care units. Multi-organ failure is basically very simply defined. If two or more organs stop working at the same time, this is already multi-organ failure. However, physicians now refer to it as multiple organ dysfunction syndrome, abbreviated MODS.
Causes
There are several causes that can lead to multiple organ failure. The two most important are accidents and bacterial poisoning. When multiple organs are injured in an accident, it can lead to a chain reaction involving the failure of other organs. The same is true for the dreaded sepsis. This is a poisoning that spreads rapidly throughout the entire body and can lead to severe inflammation everywhere. Heart disease or allergies can also trigger multi-organ failure. This can be the case when the patient suffers a life-threatening anaphylactic shock, which can paralyze the circulatory system and various organs. On the other hand, another cause is simply senility. In a very old and very weakened body, even the failure of one organ can quickly bring down the others.
Symptoms, complaints and signs
The symptoms of multiorgan failure result from the respective insufficiencies of the affected organs. For example, manifest renal failure is manifested by a decrease in the filtering capacity of the kidneys. Increased amounts of urinary substances, water and electrolytes remain in the body. This can lead to overhydration with cerebral edema, pulmonary edema or heart failure. Liver insufficiency is manifested by a yellowing of the skin (jaundice) and blood clotting disorders with prolonged bleeding time. Likewise, impaired consciousness and even coma may occur. Patients smell of raw liver from the mouth (foetor hepaticus) and exhibit a so-called flapping tremor. This is a coarse tremor of the hands. Since bile leaks from the liver vessels into the blood, people with liver failure also suffer from itching. This is particularly noticeable on the feet. Rapid breathing and shortness of breath are the leading symptoms of acute lung damage. Due to the lack of oxygen supply, the patient’s skin turns blue. This is also referred to as cyanosis. Restlessness and confusion are other symptoms that can occur in lung failure. In some patients, a drop in body temperature (hypothermia) or a rise (hyperthermia) to fever can further be observed.
Diagnosis and course
The exact diagnosis of multiorgan failure depends, of course, on which organs are affected. However, because this complication most often occurs in intensive care units, multiple organ failure is also usually detected very quickly and indicated by technical means to nursing and treatment staff. The moment multiple organ failure is detected, action must be taken very quickly, as any delay dramatically reduces the patient’s chances of survival.
Complications
Multi-organ failure due to serious illness, infection, shock reactions, allergies, or severe nutritional deficiency is already a complication that increases in severity with the number of failing organ systems. If the functions of individual organs have to be compensated for by intensive care measures, this involves considerable intervention in the patient. For example, operations and organ removal may be necessary, which once again carry their own risks.Removal of organs leads to lifelong dependence on machines such as dialysis machines (kidneys) or ventilators (in the case of failing lungs). Particularly dangerous is the occurrence of sepsis, which can occur as a result of dead organs and cellular and metabolic toxins released into the body. The poisoning causes further inflammation and loss of other organ functions. In addition, as a result of multiple organ failure, or even induced coma in such a case, oxygen deficiency of brain areas may occur. The damage caused is not reversible and subsequently affects the affected person forever. If the liver or brain are affected by sepsis, which occurs in the course of multiple organ failure, medical measures are exhausted. The same is true in the case of complete liver failure as part of multiple organ failure. Brain death is equivalent to death. The mortality rate increases with the amount of failing organs and sequelae.
When should you see a doctor?
In the event of multiple organ failure, an emergency physician should be called immediately or the hospital should be visited directly. If medical treatment is not initiated quickly, multiorgan failure usually leads to the death of the affected person. The earlier the disease is diagnosed and treated, the higher the chances of recovery of the affected person. In most cases, however, the patient in multiorgan failure is already in a hospital or undergoing other medical treatment. Patients suffer from severe pain, fever, shortness of breath and disorders of consciousness. They are often no longer able to walk, eat or drink on their own and need help from other people in their daily lives. If these symptoms occur, a physician must immediately perform an examination. Furthermore, heart failure or kidney failure may also occur. Cyanosis or other respiratory problems can also indicate multi-organ failure and should be examined. The treatment depends strongly on the affected organs and is usually carried out in a hospital. However, it is not generally possible to predict whether this will result in a positive course of the disease. Often, the life expectancy of the affected person is significantly reduced by the multiple organ failure.
Treatment and therapy
The treatment of multiorgan failure naturally depends on the organs involved, but also on the trigger of the complication. For example, if sepsis is the starting point for the organ failure, the focus of inflammation must be identified and eliminated as soon as possible, and the patient is also treated with antibiotics. In the case of more severe external injuries, such as those caused by an accident, the affected organs may need to be supported in their function by machines or even replaced. An important tool in the treatment of multiple organ failure is artificial coma. However, physicians prefer the term “artificial deep sleep”. In this process, the patient is placed in a coma-like state by means of various drugs. This is to protect the brain from the effects of multiple organ failure. Once the brain is affected, there is usually no saving the patient. Regions of the brain that are touched by MODS, such as from lack of oxygen, remain irrevocably damaged. Due to the artificial deep sleep, all bodily functions are significantly shut down. The body temperature also drops. As a result, certain regions of the body can regenerate more easily or affected organs can be better treated and restarted.
Outlook and prognosis
If multiorgan failure occurs in a patient, the chance of survival is very low. This depends on the organs that are restricted or failed, as well as the possibility of treatment. If multiple organ failure is not treated promptly, death is inevitable. There is no prospect of spontaneous recovery or the like. The mortality rate for three failed organs is still about 80 percent, even with medical treatment. Affected patients can be partially stabilized and kept alive in an intensive care unit. How well this is done depends on the organs that have failed. For example, it is easier to replace the kidneys and lungs than the liver or heart. Failure of the cardiovascular system in particular is almost always fatal.Artificial respiration can sometimes be maintained for a very long time. Likewise, a failed gastrointestinal tract can be compensated. Since the affected person in this state usually falls into a coma or is put into one, at least the suffering seems to be limited. However, in the case of failure of several organ systems, it is often no longer to be expected that the affected person will recover well even when growing out of the coma. At best, this would be the case with the failure of a few, ideally nonvital, organ systems.
Prevention
Accidents are difficult to prevent. Against infections, however, it is. 15 percent of all patients in German intensive care units suffer a so-called nosocomial infection. Behind this is the dreaded “hospital infection.” This can lead to multiple organ failure, especially if the infection is caused by resistant pathogens. Therefore, one of the most important preventive measures against multiple organ failure is very pronounced and meticulous hospital hygiene. Allergy sufferers, on the other hand, should avoid any situation that could lead to allergic shock. Therefore, it is also fundamentally important to know exactly about one’s own possible allergic behavior.
Aftercare
Multi-organ failure leads to a shortened life expectancy in most cases. Then, follow-up care can only take on a palliative character. Physicians attempt to counteract the failure of vital organs. Intensive medical treatment is indicated. Since there is little time left, pastoral counseling plays an important role. If multiple organ failure is survived, consequential damage usually remains nevertheless. These require permanent treatment. Many patients are dependent on dialysis for the rest of their lives. A normal everyday life is hardly possible. It is important to take medication to stop the symptoms. Follow-up examinations at short intervals are common. The type of follow-up depends on the clinical picture. A conversation and physical examination take place regularly. Blood sampling is also frequent. Imaging procedures regularly support the diagnosis and provide clear information about the course of the disease. Further outpatient therapies may be prescribed. If patients belong to the small group of people in whom no secondary diseases remain, no follow-up care is necessary in view of the absence of symptoms. However, experience shows that many of those affected have problems returning to their everyday lives. Doctors therefore often prescribe sessions with a psychotherapist to achieve stabilization.
What you can do yourself
Multi-organ failure often takes a fatal course, even when it occurs in an intensive care unit and doctors have anticipated this dreaded complication. They may place the patient in an induced coma or remove affected organs, such as the kidneys. This has consequences for the survivor that will not insignificantly affect his future life. He may be dependent on dialysis and/or further therapies for the rest of his life. Under no circumstances should these therapies be omitted. This also applies to physiotherapies that are intended to mobilize the patient again. Having been so close to the brink of death leaves no trace on any patient. Even if no sequelae remain, the sufferer will struggle to resume his previous life. In any case, he should seek psychotherapeutic treatment. Group therapy with other patients is also advisable. Addresses and contacts are provided by the clinics providing treatment. Since multiple organ failure is often a complication of sepsis, the website www.sepsis-hilfe.org also provides information and assistance. The reports of patients who have survived multiple organ failure are particularly helpful here. There is no way to prevent multiorgan failure after an accident or in old age. Sepsis, on the other hand, can be prevented, which at the same time also prevents multiorgan failure.
