Gastrointestinal perfusion in septic shock.

Area of Science:

• Critical Care Medicine
• Gastroenterology
• Physiology

Background:

• Septic shock causes widespread vasodilation, myocardial depression, and impaired microcirculation.
• Gastrointestinal mucosal blood flow is notably reduced in septic shock, correlating with gut injury and barrier dysfunction.
• This compromised gut perfusion may exacerbate systemic inflammation and lead to distant organ dysfunction.

Purpose of the Study:

• To review techniques used to quantify gastrointestinal perfusion abnormalities in human septic shock.
• To assess the clinical utility and limitations of these measurements in patient management.
• To evaluate the effectiveness of current and future treatment strategies on gastrointestinal perfusion.

Main Methods:

• Review of human studies employing techniques such as tonometry, laser Doppler flowmetry, reflectance spectrophotometry, near-infrared spectroscopy, orthogonal polarisation spectral imaging, indocyanine green clearance, hepatic vein catheterisation, and plasma D-lactate measurements.
• Analysis of the ability of these methods to predict outcomes in septic shock.
• Focus on gastric tonometry as a widely used, non-invasive method.

Main Results:

• Multiple techniques can quantify gastrointestinal perfusion, with varying specific measurements.
• While these methods can predict patient outcomes, their results are not interchangeable.
• Gastric tonometry is prevalent due to its ease of use and non-invasive nature.

Conclusions:

• Current clinical decision-making is limited by the utility of gastrointestinal perfusion parameters.
• Therapies targeting improved gastrointestinal perfusion have not consistently corrected abnormalities or improved clinical endpoints.
• Future septic shock treatments require evaluation for their impact on gastrointestinal perfusion to guide management and prevent detrimental effects.