Multiple Organ Dysfunction Syndrome in Cardiac Surgery: The Role of Pathophysiology in Effective Prevention and Treatment

Introduction : Multiple organ dysfunction syndrome (MODS) is a common complication and leading cause of mortality in cardiac surgery patients. To date, effective therapeutic methods and preventive strategies for this condition remain undeveloped. Identification of the role of systemic inflammatory response syndrome (SIRS) as a key component in MODS pathogenesis facilitates the development of novel treatment approaches targeting the disease’s pathogenic mechanisms. The use of new pharmacological agents with anti-inflammatory properties as a part of comprehensive MODS therapy may significantly improve treatment efficacy and clinical outcomes in cardiac surgery patients. Objective : To systematize information on the pathophysiology of MODS, detailing the contribution of SIRS, as well as data on prevention and therapy methods. Materials and methods : In this study, scientific articles relevant to this topic were analyzed through searches of PubMed, Google Scholar, UpToDate, EMBASE databases. The search for relevant articles was performed using the following keywords: “multiple organ dysfunction syndrome”, “systemic inflammatory response syndrome”, “ischemia/reperfusion syndrome”, “mitochondrial failure”, “endothelial dysfunction”, “inhaled nitric oxide”, as well as their Russian equivalents. Inclusion criteria: relevance to selected review topic; alignment with one of the selected study designs (randomized clinical trials, experimental studies, and previously published literature reviews); studies related to a cohort of cardiac surgery patients. Exclusion criteria: studies focused on clinical observations or single case reports; studies with questionable data or results, as determined by analysis using established protocols (PRISMA, STROBE, SANRA, EQUATOR). Results : The following aspects were analyzed: the central role of SIRS as a key factor in the development of MODS; the pathogenesis of MODS, including ischemia-reperfusion injury, endothelial dysfunction, and microcirculatory disorders; and a shift in therapeutic focus from strategies aimed exclusively at replacing organ function to preventive approaches and targeted interventions addressing the underlying pathogenetic mechanisms. Conclusion : Understanding the key aspects of MODS pathogenesis may guide therapeutic progress, by enabling specific targeting of the pathogenetic mechanisms involved in MODS development.