SPLANCHNIC ISCHEMIA AND ITS ROLE IN MULTIPLE ORGAN FAILURE

Multiple organ failure remains the leading cause of death in the inten sive care unit. Increasing numbers of investigators have focused their attention on the role of gastrointestinal tract in the pathogenesis o f this syndrome. Their data indicate that inadequate gut perfusion rea ds to a measurable imbalance between oxygen delivery and the needs of the tissues, i.e., ischaemia. Gut ischaemia of sufficient duration imp airs gastrointestinal tract barrier function, facilitating the passage of enteric bacterial endotoxin into the circulation. It has been hypo thesized that production of tumor necrosis factor alpha, and other bio logic mediators by endotoxin-stimulated macrophages, triggers a genera lized and uncontrolled inflammatory response that ultimately leads to multiple organ failure. Preliminary evidence suggests that survival ca n be improved significantly if gut ischaemia is promptly identifed and aggressively treated by administration of fluids and inotropic drugs, using gastric intramucosal pH as the therapeutic endpoint. Future stu dies are needed to determine whether additional treatment modalities c an improve outcome once the inflammatory response has fully developed.