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Semin Respir Crit Care Med 2011; 32(5): 626-638
DOI: 10.1055/s-0031-1287871
© Thieme Medical Publishers

Gut Failure in the ICU

Francesco Puleo1 , Marianna Arvanitakis1 , André Van Gossum1 , Jean-Charles Preiser2
  • 1Department of Gastroenterology, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
  • 2Department of Intensive Care Medicine, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
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Publikationsdatum:
11. Oktober 2011 (online)

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ABSTRACT

The role of dysfunction of the gastrointestinal tract in the pathogenesis of multiple organ failure (MOF) complicating the course of critically ill patients has been suspected for more than 40 years. However, several hypotheses have been proposed and sometimes refuted to establish a link. This review summarizes the current knowledge on gastrointestinal physiology and recapitulates existing evidence on the link between gastrointestinal dysfunction and MOF. The gastrointestinal tract has various functions apart from digestion. It produces hormones with local and systemic effects, plays a major role in immunological function, and serves as a barrier against antigens within its lumen. Gastrointestinal dysfunction or gut failure is frequently encountered in critical care patients and is associated with bacterial translocation, which can lead to the development of sepsis, initiation of a cytokine-mediated systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), and death. The aim of this manuscript is to define gut failure, to review physiopathological mechanisms and clinical implications, and, finally, to suggest preventive measures.

KEYWORDS

Gut failure - bacterial translocation - sepsis - multiple organ failure - critical care