THE ROLE OF THE GUT IN THE DEVELOPMENT OF MULTIPLE ORGAN DYSFUNCTION IN CARDIOTHORACIC PATIENTS

Interest in the importance of the gut after injury or operation has waxed and waned over this century. Recent studies implicate the gut in septic complications and multiple organ failure after trauma, operations including cardiothoracic procedures, starvation, and other serious illnesses. Changes in the gut in sick patients include stress ulceration, bacterial overgrowth from stress ulceration prophylaxis, mucosal atrophy, loss of barrier function, increased permeability, and bacterial translocation. Such changes in relation to multiorgan failure are reviewed, along with methods to support the gut and prevent gastrointestinal failure. Preventive measures include stress ulceration prophylaxis, selective gut decontamination, enteral feeding, and adjuvants to promote gut function such as glutamine, fiber, and growth hormone. In cardiothoracic operations, the gut may be altered by the ''whole body'' inflammatory processes of cardiopulmonary bypass. Gastrointestinal complications after cardiothoracic operations are related primarily to low flow states. In 5,924 patients having cardiothoracic operations at St. Louis University Hospital from 1985 to 1991, multiorgan failure developed in 128 patients, with a mortality of 78%. Significant gastrointestinal problems occurred and contributed to multiorgan failure in a number of these patients. Support of the gastrointestinal tract and the prevention of multiorgan failure are important for the cardiothoracic surgeon.