[Prevention of multiple organ dysfunction syndrome in severely injured patients--current approach].

INTRODUCTION: Multiple organ dysfunction syndrome (MODS) is frequent after trauma. Predisposing factors for MODS after trauma are: hypovolemic shock, massive volume replacement, time of resuscitation before hospitalization, systemic inflammatory response syndrome, infection, sepsis. Prevention of tissue hypoxia is a priority in prevention of MODS.

MONITORING THE ADEQUACY OF TISSUE OXYGENATION: Assessment of tissue oxygenation and potential hypoxia is indirect, based on measuring aspects of whole body oxygen transport and uptake, some regional parameters and indirect biochemical markers. Assessing oxygen transport involves: clinical evaluation of the patient, delivery of oxygen to the alveoli, oxygenation of arterial blood, delivery of oxygen to the tissues (DO2), oxygen uptake (VO2), oxygenation of the mixed venous blood, lactate and assessment of regional PCO2 or pH.

THERAPEUTIC PRINCIPLES: Haemodynamic optimization for improvement of perfusion and tissue oxygenation is of primary importance. Nutritional support antibiotic prophylaxis, pain relief, sedation and other therapeutic modalities allow patient to survive a trauma and decrease risk of systemic complications.

CONCLUSION: Tissue hypoxia and oxygen debt in injured patients are major factors which determine development of MODS. Prevention of MODS starts with respiratory and circulatory resuscitation and monitoring of tissue oxygenation prehospitally and hospitally. The first line therapy, "goal directed therapy" is not obligatory. Nutritional support, antibiotic therapy, analgesia, sedation and other therapeutic modalities contribute the ability of injured patients to survive and decrease the incidence of MODS.