Splanchnic resuscitation: a strategy for preventing liver failure in sepsis

Liver failure is commonly encountered in the critically ill, septic patient. This hepatic dysfunction occurs as a wide spectrum of abnormalities, ranging from mild chemical derangements to fulminant liver failure. The syndrome of multiple system organ system failure due to sepsis is often complicated by alterations in splanchnic/hepatic function. Knowledge of gut pathophysiology with resultant changes in substrate metabolism, synthetic function, cytokine release, and the detrimental effects on other organ systems is rapidly expanding. The functions of these pathophysiologically produced factors include extensive autocrine, paracrine, and endocrine effects. Evidence suggests that adequate resuscitation during sepsis, which is measured by systemic end-points, may result in inadequate splanchnic blood flow and oxygen delivery. The addition of serial measurements of splanchnic end-points may limit the hepatic failure encountered in multiple system organ failure due to sepsis.