Trauma ans sepsis induced splanchnic and hepatic ischemia and reperfusion injury

MODS is, with an iocidence of 10-25% and a mortality of 50-70%, the most severe complication after severe trauma 72_ MODS is a prototypical exemplar of the application of complexity theory to an understandiog of the pathophysiology of critical illness 56, 74_ It arises through the ioteractions of a network of physiologic iosults iocludiog iojury, tissue ischemi~ bacteremi~ endotoxemi~ the host inflammatory response, and the interventions used to sustain organ function during a time of otherwise lethal iosufficiency. Its mediators are many and ioterdependent, with the activity of one induciog the expression of others that amplifY, inlnbit, or otherwise modifY the expression of the process 19. The implications of an understandiog of the complex nature of organ dysfunction are critical to the development of rational strategies to prevent or treat the process. Strategies directed agaiost events late io the process may be effective but are unlikely to have a significant effect on a process whose expression, at least from the perspective of the element targeted, has become autonomous 4, 18, 75. In contrast, ischemia and reperfusion iojury to both the iotestine and the liver appears to be a relatively early event io the process ofpost-iojury development of MODS, as outlioed io figure L Therefore, a target-oriented approach includiog early augmentation of iotestinal and hepatic perfusion and oxygenation seems conceptually a more attractive therapeutic option, either as a preventive measure for subjects at risk or as a promising treatment modality in the whole treatment strategy for patients with MODS.

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