Le suicide chez les patients hospitalisés

Proulx, Francesca; Grünberg, Fréderic

doi:10.7202/032317ar

Cited by 4 publications

References 36 publications

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Multiple Organ Dysfunction Syndrome

Proulx

Leteurtre

Joyal

et al. 2014

Pediatric Critical Care Medicine

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IntroductionProgressive organ dysfunctions were fi rst reported 50 years ago in the surgical literature. In 1963, adult patients with severe peritonitis were found to develop a state of high output shock and respiratory failure requiring mechanical ventilation. Biochemical and mechanical factors were presumed to explain the severe deterioration in these patients [ 1 ]. Multiple Organ Dysfunction Syndrome AbstractMultiple organ dysfunction syndrome (MODS) occurs after a life-threatening primary insult, including severe infection, hypoxic-ischemic injury, or other serious injuries. It represents a continuum of physiological abnormalities rather than a distinct state (present or absent). Young age and chronic health conditions are the most important risk factors for the development of MODS. Increasing number of dysfunctional organs is correlated with mortality, greater use of resources, and prolonged stay in pediatric intensive care units. Severe insults converge towards a common systemic response resulting in organ dysfunctions, yet the underlying mechanism remains ill-defi ned. Acute illnesses may trigger severe infl ammatory response resulting in cytokine liberation, activation of coagulation, development of shock and capillary leak. Most experimental therapies to date have focused on attenuating the initial infl ammatory response with little benefi ts in humans. As the initial infl ammatory storm subsides, relative immune suppression becomes a major contributor to the disease process. Consequently, MODS patients are highly vulnerable to nosocomial infections. Metabolic demands and neuroendocrine responses also follow a similar seesaw pattern of over-activation followed by a state of relative suppression. Therefore, MODS may emerge from the cumulative suppression of metabolic, neuroendocrine, and immune functions resembling a state of dormancy, hypothesized to be an evolutionary protective cellular mechanism in response to overwhelming injuries. Diagnosis of MODS should encourage physicians to uncover the underlying etiology that may require a specifi c therapy. The symptomatic management of organ dysfunctions must be carefully assessed in the context of systemic interactions with other failing organs. Although long term outcome data of critically ill children with MODS is limited, 60 % of survivors are reported to have a normal quality of life with minimal health problems. Keywords

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