Critical Care Focus 9: The Gut - part 1 potx

Critical Care Focus9: The Gut EDITOR DR HELEN F GALLEY Senior Lecturer in Anaesthesia and Intensive Care University of Aberdeen EDITORIAL BOARD PROFESSOR NIGEL R WEBSTER Professor of Ana

Critical Care Focus

9: The Gut

Critical Care Focus

9: The Gut

EDITOR

DR HELEN F GALLEY

Senior Lecturer in Anaesthesia and Intensive Care

University of Aberdeen

EDITORIAL BOARD

PROFESSOR NIGEL R WEBSTER

Professor of Anaesthesia and Intensive Care

University of Aberdeen

DR PAUL G P LAWLER

Clinical Director of Intensive Care University of Aberdeen

DR NEIL SONI

Consultant in Anaesthesia and Intensive Care Chelsea and Westminster Hospital

DR MERVYN SINGER

Professor of Intensive Care

University College Hospital, London

First published in 2002

by BMJ Books, BMA House, Tavistock Square,

London WC1H 9JR www.bmjbooks.com www.ics.ac.uk

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 0-7279-1679-3 Typeset by Newgen Imaging Systems (P) Ltd, Chennai.

Printed and bound in Spain by GraphyCems, Navarra

ANNA M BATCHELOR

MARK C BELLAMY

NIGEL SCOTT

JOHN C MARSHALL

ULF HAGLUND,HELEN F GALLEY

6 Medical management of non-variceal upper

PAUL WINWOOD

JOHN R CLARK,JANE EDDLESTON

H F Galley (ed) Critical Care Focus 3: Neurological Injury, 2000.

H F Galley (ed) Critical Care Focus 4: Endocrine Disturbance, 2000.

H F Galley (ed) Critical Care Focus 5: Antibiotic Resistance and Infection

Control, 2001.

H F Galley (ed) Critical Care Focus 6: Cardiology in Critical Illness, 2001.

H F Galley (ed) Critical Care Focus 7: Nutritional Issues, 2001.

H F Galley (ed) Critical Care Focus 8: Blood and Blood

Transfusion, 2002.

CRITICAL CARE FOCUS: THE GUT

management of the post-operative fistula patient can be summarised using the ‘4 Rs’: Resuscitation, Restitution, Reconstruction and Rehabilitation This article outlines the approach of the Intestinal Failure Unit at Hope Hospital, Manchester, UK, in dealing with intestinal fistulae The large majority of patients referred to this unit are ultimately discharged home – only about 10% of those referred die after admission The usual cause of death is multiple organ failure Not surprisingly death is related to poor performance score, low serum albumin and age at referral Older patients and patients with significant co-morbidity do particularly badly

The gut as the motor of organ failure

John C Marshall

Data from a large number of published human studies support the hypothesis that the gastrointestinal tract contributes to morbidity and mortality in critically ill patients on the intensive care unit Changes in proximal gut flora in the critically ill patient predict nosocomial infection with the same organism, while therapeutic measures targeting the gut clearly reduce rates of nosocomial infection and may have an impact on mortality Modulation of the systemic inflammatory response through gut-derived measures has been no more successful than modulation of that response through more conventional systemic forms of mediator-directed therapy But although the gastrointestinal tract is an important factor in

nosocomial infection, to what extent does infection per se alter outcome in

critical illness? The aim of this article is to provide a background to the evolution of the concept that in the critically ill patient the gut and its interactions with the liver play an important role in the clinical picture commonly seen in critically ill patients

Mesenteric ischaemia

Ulf Hagland, Helen F Galley

In this article the physiology of the intestinal circulation of importance for the understanding of intestinal ischaemia is briefly outlined The key to our understanding and successful treatment of intestinal ischaemia lies in a better knowledge of this physiology The potential for intestinal vasoconstriction causing non-occlusive intestinal ischaemia is discussed, and the role of the reperfusion component of ischaemic injury Maintenance of the mucosal cell barrier is essential in preventing the translocation of bacteria and endotoxin into the portal circulation and mesenteric lymphatics and the importance of this in the critically ill patient

is addressed