Understanding gastrointestinal perfusion in critical care: so near, and yet so far.
An association between abnormal gastrointestinal perfusion and critical illness has been suggested for a number of years. Much of the data to support this idea comes from studies using gastric tonometry. Although an attractive technology, the interpretation of tonometry data is complex. Furthermore, current understanding of the physiology of gastrointestinal perfusion in health and disease is incomplete. This review considers critically the striking clinical data and basic physiological investigations that support a key role for gastrointestinal hypoperfusion in initiating and/or perpetuating critical disease.
Ackland
G
G
Centre for Anaesthesia, University College London, London, UK.
Grocott
M P
MP
Mythen
M G
MG
D001784:Blood Gas Analysis; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004064:Digestive System / Q000098:blood supply* / Q000503:physiopathology*; D004068:Digestive System Physiological Phenomena; D004435:Eating / Q000502:physiology; D015444:Exercise / Q000502:physiology; D005745:Gastric Acidity Determination; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007511:Ischemia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008991:Monitoring, Physiologic / Q000379:methods; D009102:Multiple Organ Failure / Q000209:etiology; D013152:Splanchnic Circulation / Q000502:physiology; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D016896:Treatment Outcome