Sirs and Mods

Systemic Inflammatory Response Syndrome
Copyright © 2017, Elsevier

Inc. All Rights Reserved.
(SIRS)
and
Multiple Organ Dysfunction Syndrome
(MODS)
SIRS
• Systemic inflammatory response syndrome (SIRS) is a systemic
inflammatory response to a variety of insults
• Generalized inflammation in organs remote from the initial insult
SIRS
• Triggers
• Mechanical tissue trauma: burns, crush injuries, surgical procedures
• Abscess formation: intraabdominal, extremities
• Ischemic or necrotic tissue: pancreatitis, vascular disease, MI
SIRS
• Triggers
• Microbial invasion: bacteria, viruses, fungi
• Endotoxin release: gram-negative bacteria
• Global perfusion deficits: postcardiac resuscitation, shock states
• Regional perfusion deficits: distal perfusion deficits
MODS
• Multiple organ dysfunction syndrome (MODS) is failure of two or
more organ systems
• Homeostasis cannot be maintained without intervention
• Results from SIRS
Relationship of Shock, SIRS, and MODS

Case Study
SIRS (©WavebreakMedia/Thinkstock)
• K.R., a 28-year-old woman, is brought to the ED by her mother with

confusion, fever, and “flu for past week.”
• She has been vomiting for the past 2 days and has noted generalized
edema.
• Vital signs: T 103.5° F , HR 112, R 24,
BP 88/54
SIRS and MODS
Pathophysiology
• Consequences of inflammatory response
• Release of mediators
• Direct damage to endothelium
• Hypermetabolism
• Increase in vascular permeability
• Activation of coagulation cascade
SIRS and MODS
Pathophysiology
• Organ and metabolic dysfunction
• Hypotension
• Decreased perfusion
• Formation of microemboli
• Redistribution or shunting of blood
SIRS and MODS
Pathophysiology
• Respiratory system
• Alveolar edema
• Decrease in surfactant
• Increase in shunt
• V/Q mismatch
• End result: ARDS
SIRS and MODS
Pathophysiology
• Cardiovascular system
• Myocardial depression and massive vasodilation
• Results in SVR and BP
• Baroreceptors respond to enhance CO
• Albumin and fluid move out of blood vessels
SIRS and MODS
Pathophysiology
• Neurologic system
• Mental status changes due to hypoxemia, inflammatory mediators, or
impaired perfusion
• Often early sign of MODS
SIRS and MODS
Pathophysiology
• Renal system
• Acute kidney injury (AKI)
• Hypoperfusion
• Release of mediators
• Activation of renin-angiotensin-aldosterone system
• Nephrotoxic drugs, especially antibiotics
SIRS and MODS
Pathophysiology
• GI system
• Motility decreased: abdominal distention and paralytic ileus
• Decreased perfusion: risk for ulceration and GI bleeding
• Potential for bacterial translocation
SIRS and MODS
Pathophysiology
• Hypermetabolic state
• Hyperglycemia-hypoglycemia
• Insulin resistance
• Catabolic state
• Liver dysfunction
• Lactic acidosis
SIRS and MODS
Pathophysiology
• Hematologic system
• DIC
• Electrolyte imbalances
• Metabolic acidosis
Case Study
• K.R. is admitted to ICU with a possible diagnosis of sepsis.

• Her urine output is amber and only 15 mL/2 hr.
• Chest x-ray shows bilateral infiltrates.
• WBC count and lactic acid are elevated.
SIRS and MODS
Interprofessional Care
• Prognosis for MODS is poor
• Goal: prevent the progression of SIRS to MODS
• Vigilant assessment and ongoing monitoring to detect early signs of
deterioration or organ dysfunction are critical
SIRS and MODS
• Interprofessional care for patients with MODS focuses on
• Prevention and treatment of infection
• Maintenance of tissue oxygenation
• Nutritional and metabolic support
• Appropriate support of individual failing organs
Case Study
• K.R. has a urinary catheter inserted as well as a central venous

catheter.
• Her doctor talks with her mother about the possibility of mechanical
ventilation.
• K.R.’s mother asks why she is so sick and what can be done for her.
SIRS and MODS
• Prevention and treatment of infection
• Aggressive infection control strategies to decrease risk for nosocomial
infection
• Strict asepsis
• Assess need for invasive lines
• Once an infection is suspected, institute interventions to control source
SIRS and MODS
• Maintenance of tissue oxygenation
• Decrease O2 demand and increase O2 delivery
• Sedation
• Mechanical ventilation
• Analgesia
• Rest
SIRS and MODS
• Nutritional and metabolic needs
• Goal of nutritional support: preserve organ function
• Total energy expenditure is often increased 1.5 to 2.0 times
SIRS and MODS
• Use of the enteral route is preferred to parenteral nutrition
• Monitor plasma transferrin and prealbumin levels to assess hepatic protein
synthesis
• Provide glycemic control
SIRS and MODS
• Use of the enteral route is preferred to parenteral nutrition
• Monitor plasma transferrin and prealbumin levels to assess hepatic protein
synthesis
• Provide glycemic control
SIRS and MODS
• Support of failing organs
• ARDS: aggressive O2 therapy and mechanical ventilation
• DIC: appropriate blood products
• Renal failure: continuous renal replacement therapy or dialysis
Audience Response Question

A patient with a history of alcoholism is admitted to the ICU with
hemorrhage from esophageal varices. Admission VS are BP 84/58
mm Hg, HR 105, and RR 32 breaths/min. The nurse recognizes the
onset of systemic inflammatory response syndrome (SIRS) upon
finding
a. pulmonary edema.
b. cardiac dysrhythmias.
c. absent bowel sounds.
d. decreasing blood pressure.
Audience Response Question
A patient admitted to the hospital from a long-term care facility

appears to be in the late stage of shock with systemic inflammatory
response syndrome (SIRS). Which order implemented by the nurse has
the highest priority?
a. Insert an indwelling urinary catheter.
b. Insert two large-bore intravenous catheters.
c. Administer 0.9% normal saline at 100 mL/hr.
d. Administer 100% oxygen by non-rebreather mask.

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Systemic Inflammatory Response Syndrome

Copyright © 2017, Elsevier

Relationship of Shock, SIRS, and MODS

• K.R., a 28-year-old woman, is brought to the ED by her mother with

• K.R. is admitted to ICU with a possible diagnosis of sepsis.

• K.R. has a urinary catheter inserted as well as a central venous

Audience Response Question

Audience Response Question

A patient admitted to the hospital from a long-term care facility

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