Monitoring intestinal ischaemia.
OBJECTIVE
To review the clinical and experimental methods of detecting intestinal ischaemia and to assess their value in current clinical practice.


METHODS
Relevant articles and published reviews on intestinal ischaemia and/or infarction.


RESULTS
The incidence of acute mesenteric ischaemia has increased substantially over the last few decades. Death rates of 70% to 90% have been reported for this condition. Improved management depends upon prompt diagnosis and early aggressive management. Despite mounting evidence that ischaemic intestinal injury may be frequent and may be a cause of multi-organ failure, accurate monitor-ing of the intestinal circulation in critically ill patients continues to be a distant goal. The need for a reliable, specific test of intestinal ischaemia has been recognised for many years. Numerous potential monitors have been evaluated including intraluminal pCO2, abdominal CT, abdominal MRI and specific plasma enzymes, but few have shown potential to be clinically useful. At present no specific test for intestinal ischaemia and/or infarction is in routine clinical use. Development of a specific test to monitor for intestinal injury would be of great clinical value. Further work will inevitably lead to the development of useful markers.


CONCLUSIONS
Accurate detection of intestinal ischaemia in the critically ill patient is often difficult. While numerous tests have been examined to diagnose and monitor intestinal ischaemia and/or infarction most exhibit an unacceptably low specificity and sensitivity.
Intensive Care Unit, The Geelong Hospital, and Deakin University, Geelong, Victoria. charliec@barwonhealth.org.au
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Glenister