Multiple-Organ Failure and the Gut

It has been suggested that gut hypoxia is important in the development of multiple-organ failure, by triggering increased mediator release, and through altered gut mucosal permeability leading to increased bacterial translocation. Studies generally show that the gut is at risk during circulatory failure, as there is often redistribution of blood flow to other more vital organs. Splanchnic blood flow may not fall in all cases of acute circulatory failure, but an imbalance between oxygen demand and the level of oxygen supply can result in regional ischemia. In septic shock this may be exacerbated by an increase in oxygen demand and alterations in oxygen extraction. If the resultant gut hypoxia is indeed related to multiple-organ failure, then by improving, or at least maintaining, splanchnic blood flow we may be able to improve the associated high mortality rates. Many ways of achieving this have been, and are still being, investigated, but at present the only established methods are adequate fluid administration with the use of adrenergic agents. Early enteral nutrition is also important to maintain gut function.