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Crit Care Clin. 2016 Apr;32(2):203-12. doi: 10.1016/j.ccc.2015.11.004. Epub 2016 Feb 4.

The Gut as the Motor of Multiple Organ Dysfunction in Critical Illness.

Author information

1
Department of Surgery, Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA.
2
Department of Surgery, Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: cmcoop3@emory.edu.

Abstract

All elements of the gut - the epithelium, the immune system, and the microbiome - are impacted by critical illness and can, in turn, propagate a pathologic host response leading to multiple organ dysfunction syndrome. Preclinical studies have demonstrated that this can occur by release of toxic gut-derived substances into the mesenteric lymph where they can cause distant damage. Further, intestinal integrity is compromised in critical illness with increases in apoptosis and permeability. There is also increasing recognition that microbes alter their behavior and can become virulent based upon host environmental cues. Gut failure is common in critically ill patients; however, therapeutics targeting the gut have proven to be challenging to implement at the bedside. Numerous strategies to manipulate the microbiome have recently been used with varying success in the ICU.

KEYWORDS:

Critical illness; Gut; Intestine; MODS; Sepsis

PMID:
27016162
PMCID:
PMC4808565
[Available on 2017-04-01]
DOI:
10.1016/j.ccc.2015.11.004
[Indexed for MEDLINE]
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