From the Guidelines
End organ dysfunction refers to the failure or impairment of vital organs, such as the heart, lungs, liver, kidneys, and brain, due to severe illness or injury, and is often identified through abnormal laboratory values, such as elevated creatinine or abnormal liver enzymes, and requires early recognition and aggressive management to prevent a high mortality rate. This condition typically affects major organs and often occurs in critically ill patients, particularly those with sepsis, severe trauma, or other systemic inflammatory conditions 1. The presence of a single end-stage chronic illness, such as stage 3–4 congestive heart failure or oxygen-dependent lung disease, chronic kidney disease requiring dialysis, or uncontrolled metastatic cancer, may cause significant symptoms or impairment of functional status and significantly reduce life expectancy 1. Treatment focuses on addressing the underlying cause while providing supportive care to the affected organs, which may include mechanical ventilation for respiratory failure, dialysis for kidney dysfunction, vasopressors for cardiovascular support, or other organ-specific interventions 1. Key considerations in managing end organ dysfunction include the evaluation of right ventricular function, as postoperative right ventricular failure can greatly increase perioperative mortality and reduce survival 1. In some cases, left ventricular assist devices (LVADs) may be used as a bridge to recovery, candidacy, or transplantation, and earlier implantation in less severely ill patients may lead to better outcomes 1. Overall, the management of end organ dysfunction requires a comprehensive and multidisciplinary approach to address the underlying causes and prevent further organ damage. Some key points to consider in the management of end organ dysfunction include:
- Early recognition and aggressive management to prevent a high mortality rate
- Evaluation of right ventricular function to guide treatment decisions
- Use of mechanical ventilation, dialysis, and vasopressors as needed to support affected organs
- Consideration of LVADs as a bridge to recovery, candidacy, or transplantation in selected patients
- A comprehensive and multidisciplinary approach to address the underlying causes and prevent further organ damage.
From the Research
Definition of End Organic Dysfunction
- End organic dysfunction refers to the failure of one or more organs in the body, which can be caused by various factors such as infection, trauma, or disease 2.
- It is a continuum of cumulative organ dysfunction, ranging from mildly altered function to total and irreversible organ failure 2.
Organs Affected by End Organic Dysfunction
- The organs most commonly affected by end organic dysfunction include the pulmonary, cardiovascular, renal, hepatic, hematologic, and central nervous systems 2, 3.
- Each of these organs can experience dysfunction or failure, leading to a range of clinical manifestations and complications 3.
Scoring Systems for Organ Dysfunction
- Various scoring systems have been developed to describe and quantify organ dysfunction in critically ill patients, including the Sequential Organ Failure Assessment (SOFA) score and the Multiple Organ Dysfunction Score (MODS) 2.
- These scoring systems can be used to track disease progression, predict outcomes, and guide treatment decisions 2.
Clinical Implications of End Organic Dysfunction
- End organic dysfunction is a major cause of morbidity and mortality in critically ill patients, and its recognition and management are crucial to improving patient outcomes 2, 3.
- A comprehensive understanding of the pathophysiologic mechanisms underlying end organic dysfunction is essential for healthcare professionals to provide effective care and improve patient outcomes 3.