目的: Gut dysfunction or failure is a very common complication in critically ill patients and would in turn deteriorate primary disease, giving rise to a vicious cycle in critical illness. Therefore, it is believable that gut is the motor organ during the development of Multiple Organ Dysfunction Syndrome (MODS). This review serves to update new data and new understanding on the roles of the gut as model of organ failure in critical illness.
 

方法: Although many therapy trials aim to prevent and treat gut dysfunction have shown some benefits in preclinical models, very limited successful specific agents are of value to gut failure in critical illness patients. Moreover, despite remarkable advances in nutrition supply techniques and agents that enable management of patients with MODS, waiting for gut function recover or gut “rest”, patients with gut failure is still associated with high morbidity and mortality rate. Thus, focusing only on gut damage and loss of gut function has not been sufficient to explain the central role of gut in critical illness and fail to improve outcomes of patients with acute gut injury or failure. Recent data from basic and clinical research have begun to prove concepts, such as “ if the bowl works, use it” (and if it does not work, make it work), even in the process of gut failure. Growing evidence confirms critical illness leads to ICU “illness-promoting dysbiosis" (loss of ‘health-promoting’ microbes and overgrowth of pathogenic bacteria) that is contributed to increase MODS in ICU patients. Additional, more findings have elucidated complex organ interactions between gut and distant organs in critical illness.
 

结果: The gut plays several vital roles: nutrient absorption, intestinal barrier function and preserving “suitable location” for microflora. So how to maintain these important functions during the process of gut failure in critical illness might be future-targeted therapies. We hope with new insight and clear understand of gut as model organ of critical illness, gut might be motor of more effective treatment target and be key organ to improve patient’s outcomes in critical patients in the future.
contributed to increase MODS in ICU patients. Additional, more findings have elucidated complex organ interactions between gut and distant organs in critical illness.

结论: In conclusion, the gut is the original organ in the process of MODS in critical illness. First, the basic insights into the gut function shows that is more complex system compared with other organ, including interaction with outside, consistently renewed intestinal tissue, digestion and absorption, microflora in intestinal tract, gut barrier. Second, gut dysfunction or failure emerges in very early stage in critical illness, beside of crosstalk between gut and other distant important organs, such as gut-liver axis, gut-lung crosstalk, gut-kidney crosstalk, gut-brain crosstalk. Finally, new deeply insights into the gut as model of organ failure and its intimate relationship with other system are expected to lead to more efficacious treatment modalities for critical illness in the future.
d complex organ interactions between gut and distant organs in critical illness.