Multiple organ dysfunction syndrome: what do we know about pain management? A narrative review

Abstract

Multiple organ dysfunction syndrome (MODS) is observed in 40% of adult patients and 56% of pediatric patients admitted to the intensive care unit (ICU). Mortality in case of MODS can reach 50% and more. Pain management in this population of patients is always a big challenge due to systemic derangements. We give a narrative review of this problem and the recommended lines of action here. We performed a literature search for a period from 1984 to 2018 in Google Scholar, PubMed, Medline, Embase, and Cochrane. Data from 45 articles devoted to the problems of MODS, severe sepsis, heart, liver and renal failures, coagulation disorders and pain management were accumulated and presented here. First step in the management of any pathology is diagnosis and assessment. Organ dysfunction in adults can be assessed according to Sequential Organ Failure Assessment (SOFA) score, and other Systems in pediatric patients. Acetaminophen, tramadol and fentanyl is a safe option for analgesia in MODS after dose adjusting according to liver failure or eGFR. Other methods of analgesia can be used in specific types of organ failure, but have limitations or are not well studied, so they are best avoided or used with caution in patients with MODS. In this article pain management strategies in each particular failure are presented and an algorithm for pain management has been suggested by the authors. Further investigations are required in order to determine the best modalities for pain management in this group of patients.

Citation: Dmytriiev D. Multiple organ dysfunction syndrome: what do we know about pain management? A narrative review. Anaesth. pain & intensive care 2019;23(1):84-91