Is the gut responsible for multiple organ failure?
Multiple organ failure is the consequence of many pathological processes, an acute reduction in oxygen supply being one of the most important. The splanchnic region is particularly susceptible to hypoxic injury, and the ischaemic gut mucosa may act as a neutrophil activating site. This is followed by leukocyte adhesion to endothelium and migration into the tissues where cytotoxic chemicals are released, producing tissue injury. This process is aggravated by multiple and sequential physiological insults, some of which may not be evident using basic clinical monitoring. The factors which precipitate cell injury and organ failures may be amenable to relatively simple preventative interventions, but once damage has occurred the process becomes increasingly complex and self-sustaining. Natural defence systems may become pathologically hyperactive, or suppressed, at different stages in critical illness, making it difficult to target therapies directed at the immunoinflammatory cascade with any degree of accuracy or safety, explaining in part the failure of immunotherapy for sepsis. There are significant genetic and constitutional components to susceptibility to critical illness, the most important of which affect cardiac reserve and the ability to maximise tissue oxygen supply. Whether the gut is the most important target organ for oxygen delivery in stress is still the subject of continued research.
Bion
J F
JF
Intensive Care Medicine, University of Birmingham, England.
D004064:Digestive System / Q000503:physiopathology*; D020022:Genetic Predisposition to Disease; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D011183:Postoperative Complications; D014947:Wounds and Injuries / Q000150:complications