iPH and Splanchnic Dysfunction Management

Abstract

There is evidence from experimental and clinical studies that the gastrointestinal tract is a key player in the development of endotoxemia, sepsis, and multiple organ failure [1–4]. Therefore, the assessment of perfusion and function of the splanchnic organs have become of major interest, both for investigators and clinicians. The currently available clinical tools are, among others, the assessment of gastrointestinal permeability, liver function tests, such as monoethylglycine xylidide (MEGX) production from lidocaine, and many others, regional and local blood flow measurements, such as estimation of splanchnic blood flow by hepatic uptake of substances that are metabolized by the liver and distributed in the plasma, such as indocyanine green, Laser Doppler flow, and tonometry. The estimation of gastric and intestinal mucosal pH by tonometry was introduced in the 1980, and further developed during the last 15 years to semi- and fully automated methods. An impressive number of both clinical and experimental studies has been conducted so far with tonometry, but the method has not yet gained clinical acceptance. There are many reasons for this. Some are listed in Table 1.