INFECTION, THE GUT AND THE DEVELOPMENT OF THE MULTIPLE ORGAN DYSFUNCTION SYNDROME

It has been hypothesised that failure of the gut is an important patho physiological phenomenon of the generalised inflammatory response that leads to the multiple organ dysfunction syndrome (MODS). Abnormal col onisation, infections of gut origin, bacterial translocation are all s igns of gut failure that have been implicated in the pathogenesis of M ODS. We have concluded after summarising published experimental and cl inical studies that have tried to-correlate the occurrence or preventi on (by selective decontamination of the digestive tract) of these phen omena with the development of MODS, it seems that in some patients it is clear that loss of intestinal barrier function or the onset of infe ction precedes the development of MODS. In other patients, however, th is relationship is not so clear and it seems that these phenomena may reflect a failure of the host's immune and mechanical defence systems and are epiphenoma of critical illness. The causal relation between th ose phenomena and the development of MODS are complex and need further clarification.