Targeting the gut in shock and organ failure

Multiple organ system failure (MOSF) remains a common cause of morbidity and mortality in intensive care. Despite therapeutic advances in organ system support, the incidence of MOSF remains high, varying from 14 to 38%.1,2 Although the gastrointestinal (GI) and hepatic response to critical illness remains incompletely understood, evidence is accumulating that GI function, particularly splanchnic bed perfusion and intestinal mucosal integrity, occupies a crucial role in the development and perpetuation of MOSF.3-6 The purpose of this review is to provide a brief overview of the role of the gut in the development of MOSF, to describe current monitoring techniques to assess the adequacy of gut perfusion and function, and to analyze the impact of available gut-directed therapies on outcome.