급성 호흡부전증으로 기계 호흡중인 환자들에서 다발성 기관부전증에 대한 연구

Abstract

Objectives: The syndrome of multiple organ failure (MOF) is a dynamic process of progressive physiologic failure of several, independent organ systems with a complex interrelationship among individual organs. The MOF is frequently observed in the patients receiving the intensive care, especially with mechanical ventilation, and carries a high mortality. Even though nonpulmonary organs involvement such as kidney, liver, CNS and so forth, is an important factor for MOF, it correlates most strongly to the respiratory failure. Most of hypotheses as to how the lung failure and subsequent MOF process evolve after initial injury are based on a variant of an ischemia-reperfusion type injury. A number of humoral, inflammatory mediators have been reported to be involved in the initiation and perpetuation of this syndrome. We did a prospctive study of 58 patients with the syndrome to evaluate the contributions of these complications to outcome. Methods: The study population consisted of mechanically ventilated patients with one or more organs failed, in addition to the respiratory system, enrolled in a prospective study of MOF from May 1992 to February 1993. We made the simple and general criteria for the failure of each organ as possible as we can, A major effort was made to investigate the clinical features of failed organs, the significance of infection in this syndrome. And we compared the characteristics of MOF between the survivor and nonsurvivor groups or between the infected and noninfected groups. Results: There was no significant difference in the age between the survivor and nonsurvivor groups. Infection was the most frequently associated condition in both groups, The incidences of coagulopathy and cardiovascular failure were significantly higher in the nonsurvivor group. The lung was the most prevalent focus of infection and, Staphylococcus aureus and Pseudomonas aeruginosa were the most frequent organisms. Renal, cardiovascular, and neurologic dysfunctions were significantly higher in the infected group, and disseminated intravascular coagulation was found only in this group. There was no proportional increase of mortality with increased number of involved organs. Conclusion: Coagulation and cardiovascular system were thought to play a significant role in mortality. The incidences of MOF and mortality were significantly higher in the infected group. In this study, therefore, mortality was influenced by the fact which organ was involved rather than the number of failed organs. Infection was also an important factor in the development of MOF and prognosis.