Multiple Organ Dysfunction Syndrome in the Acute Care Patient

Welcome to the EHOB Post. This monthly newsletter features educational information, industry news, company updates, and tools and resources focused on our specialties, pressure injury prevention and safe patient handling.

This week, we discuss the effects of Multiple Organ Dysfunction Syndrome (MODS) and share our clinical insight of the month about tissue tolerance.

Multiple Organ Dysfunction Syndrome

Multiple Organ Dysfunction Syndrome is a physiologic abnormality involving two or more organ systems simultaneously. It’s a process, rather than a single event, and is categorized as a dysfunction because of its potential for reversal. MODS typically involves the following organ functions: respiratory, cardiovascular, renal, hepatic, neurologic, and/or hematologic, while often including the immune and endocrine systems as well. So why not the skin? It is, after all, the largest organ in the human body.

The integumentary system includes the epidermis, dermis, hypodermis, associated glands, hair, and nails. It functions as a physical barrier between the external and internal environments. The skin is indispensable. But the debate still wages among healthcare workers on the concept of total skin failure. In the early 90s, clinician John La Puma connected the dots between organ and skin failure. His view was if organs such as the heart or kidneys were failing, it stood to reason that the skin could fail as well (1).

What Happens When the Skin Fails?

Skin failure is categorized as acute, chronic, and end-of-life (2). In the acutely ill patient, changes in the skin are directly linked to the illness at hand. Further opinion identifies that when tissue tolerance is so severely compromised, cells cannot survive in the midst of impairments such as hypoxia or mechanical stresses. So what is the connection between MODS, skin failure, and pressure injuries?

Download our clinical whitepaper to learn more about the connection between MODS and acute skin failure and to understand the value of recognizing the skin as an organ system that can fail during the MODS process.

Clinical Insight of the Month: Tissue Tolerance & Body Shape

Tissue tolerance and body shape are two factors that should be taken into account when determining a patient’s overall risk for pressure injury development.

Why is Tissue Tolerance Important?

Tissue tolerance is the ability of the skin and its supporting structures to endure a certain degree of pressure without adverse effects. In relation to positioning, it’s the length of time a patient can maintain a position without developing skin damage.

By understanding tissue tolerance and a patient’s level of risk, caregivers can alter the care plan accordingly to prevent skin damage from occurring. Pressure redistributing support surfaces, like the WAFFLE Overlay, can provide the best pressure injury protection. It’s important to know a patient’s limits!?

Effects of Body Shape – One Size Does NOT Fit All?

Body shape can impact a patient’s level of pressure injury risk. Patients with round and square shapes are at the highest risk and are also the patient population with the highest recorded weight and BMI (7). The greater the BMI, the more likely the patient falls into the round or square-shaped categories. Visual evaluation of body shape won’t replace good skin checks, but it can be a useful adjunct.

Note: Body shape and size may affect inflation levels on the WAFFLE Overlay and sizing for Position Perfect Wedges. Hand checks are imperative to ensure patients are safely and effectively protected!

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References

1. Puma, John La MD. The Ethics of Pressure Ulcers. Decubitis: May 1991 - Volume 4 - Issue 2 - p 43-45
2. Langemo, Diane K, and Gregory Brown. “Skin fails too: acute, chronic, and end-stage skin failure.”?Advances in skin & wound care?vol. 19,4 (2006): 206-11. doi:10.1097/00129334-200605000-00014
3. Asim, M., Amin, F., & El-Menyar, A. (2020). Multiple organ dysfunction syndrome: Contemporary insights on the clinicopathological spectrum. Qatar medical journal, 2020(1), 22.?https://doi.org/10.5339/qmj.2020.22
4. Kim, J. H., Shin, H. K., Jung, G. Y., & Lee, D. L. (2019). A case of acute skin failure misdiagnosed as a pressure ulcer, leading to a legal dispute. Archives of plastic surgery, 46(1), 75–78.?https://doi.org/10.5999/aps.2018.00087
5. Kim JY, Dao H. Physiology, Integument. (2022). [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing:?https://www.ncbi.nlm.nih.gov/books/NBK554386/
6. Ayello EA, Levine JM, Langemo D, Kennedy-Evans KL, Brennan MR, Sibbald GR. (2019) Reexamining the literature on terminal ulcers, SCALE, skin failure, and unavoidable pressure Injuries. Adv. Skin and Wound Care. Wolters Kluwer Health, Inc.
7. Dunk, AM, Gardner, A. (June 2016). Body shape: predictor for pressure injury risk. Wound Practice and Research, 24(2), 92-98