Organ Failure
Q1. What is organ failure?
There is no single definition for organ failure, as the criteria can differ for each organ. In general, organ failure occurs when an organ loses its ability to support the patient’s needs and perform its functions adequately. Examples of organ failure include the need for oxygen or a ventilator due to poor respiration and low blood oxygen levels, or the use of cardiac stimulants for low blood pressure. Organ functions can also be measured by indices; for example, kidney failure may present as low urine output or elevated uremic indices. Therefore, signs of organ failure vary depending on the organ affected.
When more than one organ fails sequentially, or when multiple organs fail simultaneously, this is known as multiple organ failure. The failure of one organ can lead to the failure of other organs as well. When a patient experiences failure in one organ, the mortality rate is already 15% to 20%. With each additional organ that fails, the mortality rate increases by another 15% to 20%. When three or more organs fail, the mortality rate becomes extremely high. Since some organs are more critical than others, their failure results in a higher mortality rate. For example, the mortality rate for kidney failure requiring haemodialysis is over 80%.
Q2. What are the causes of organ failure?
Organ failure can occur due to various causes, which can be categorised as infectious or non-infectious. Infectious causes may be easier to understand. For example, severe pneumonia can lead to difficulty breathing, requiring intubation support due to respiratory failure. Severe pneumonia can also cause low blood pressure, leading to septic shock. Infections can originate from multiple sources. Common issues like pneumonia or even a tooth cavity can sometimes lead to severe complications, resulting in multiple organ failure. Ludwig's angina is a type of oral infection that spreads from the floor of the mouth to the neck, potentially leading to conditions like airway obstruction and respiratory failure. Infections themselves can also trigger sepsis and other forms of organ failure.
Non-infectious causes of organ failure refer to factors such as car accidents, severe injuries, or conditions like pancreatitis, which is an inflammation not caused by an infection, but can still lead to organ failure. Simple procedures like blood transfusions are usually safe. However, losing a lot of blood and needing large volumes of transfusions may cause multiple organ failure.
Q3. What are the symptoms of organ failure?
Symptoms of organ failure vary depending on the affected organ. For example, patients with respiratory failure may experience shortness of breath and blue lips. Extremely low blood pressure may lead to shock, dizziness, or unconsciousness. Patients with kidney failure will notice decreased urine output and swelling of the body. Liver failure can cause yellowing of the eyes and skin. If the jaundice becomes severe, the skin may darken further.
Q4. When organ failure occurs, is it necessary to be transferred to the intensive care unit?
In mild cases of organ failure resulting in low blood pressure, if the patient can be stabilised with fluid resuscitation or low-dose cardiac stimulants, admission to the Intensive Care Unit (ICU) may not be necessary. However, if the organ failure is serious, requiring high-dose medications or close monitoring, or equipment available only in the ICU, then ICU admission becomes necessary. Patients with severe respiratory failure requiring endotracheal intubation or kidney failure needing dialysis should be treated in the ICU.
In the ICU, patients with multiple organ failure are primarily managed by intensive care specialists. The doctors will treat all the organs holistically, as each organ does not function in isolation, but is interconnected with the others. In certain circumstances, we may need to seek the opinions of other specialists. For example, when a patient is experiencing heart failure with poor cardiac function, we would need the assistance of a cardiologist to determine how to address cardiovascular issues, or if balloon aortic valvuloplasty is required to manage blood pressure. When a patient develops acute renal failure, we would require the help of a nephrologist to arrange for a kidney biopsy. Therefore, we often need to seek the help of other specialists in different situations.
Q5. Is organ failure reversible?
In general, organ failure can be reversible. It depends on the underlying cause and the previous condition of the organ. Organs that experience acute failure can often return to their pre-failure state. However, if the organ already had existing conditions, such as impaired kidneys, the acute failure may make it challenging to reach a full recovery. In cases of shock, once the primary condition is treated and resolved, the normal blood pressure usually resumes.
Q6. What are the new developments in organ support therapy?
In recent years, we have adopted more invasive methods to address organ failure, such as the increased use of artificial lungs (ECMO) for managing heart and lung failure. In cases of kidney failure, haemodialysis remains the primary treatment, with adjustments in dosage as needed. For liver failure, where previously there were few treatment options, advanced filters for liver dialysis are now available. However, these filters are still in the preliminary stage of clinical application. Generally, for multiple organ failure caused by infections, we usually use blood purification therapies to alleviate the symptoms.
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