SPLANCHNIC ISCHEMIA AND GUT MUCOSAL INJURY IN SEPSIS AND THE MULTIPLEORGAN DYSFUNCTION SYNDROME

The incidence of multiple organ failure syndrome (MOFS) has increased dramatically in most intensive care units (ICU) in the United States a nd is now the leading cause of death after sepsis, trauma, and burns ( 1), Despite advances in resuscitation, availability of potent antibiot ics, and modern techniques of organ support (2), the survival of criti cally ill patients with MOFS has not significantly improved since the syndrome was first described over 2 decades ago (3), In the ICU, the m onitoring and management of critically ill patients with MOFS has reli ed, in large part, on readily available measurements of global hemodyn amics and oxygen transport, Given the increased understanding of the s pecial role of splanchnic hypoperfusion in the pathophysiology of seps is and MOFS (4-5), investigators have focused more recently on regiona l blood flow and oxygen metabolism in these patients (6), In this arti cle, we first present a clinical overview of sepsis and MOFS, Current concepts of the pathogenesis and pathophysiology of MOFS are discussed , with particular emphasis on the roles of splanchnic ischemia and gut barrier failure in the development of both sepsis and the maintenance of the systemic inflammatory response that leads to MOFS, Alterations in both global and regional oxygen transport in septic shock are desc ribed to emphasize the limitations of global monitoring in the assessm ent of splanchnic tissue oxygenation, The role of gastric tonometry in the monitoring of splanchnic oxygenation and its utility in criticall y ill patients is then analyzed, In addition, the effects and clinical implications of commonly used vasoactive agents on intestinal oxygena tion are discussed, Finally, novel therapeutic strategies based on the ''gut-origin hypothesis'' of MOFS are reviewed.