The pediatric multiple organ dysfunction syndrome.
OBJECTIVE
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.


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


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.
Proulx
François
F
Division of Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Canada. fproulx_01@yahoo.ca
Joyal
Jean Sébastien
JS
Mariscalco
M Michele
MM
Leteurtre
Stéphane
S
Leclerc
Francis
F
Lacroix
Jacques
J
D017677:Age Distribution; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis