Abstract
Inadequate splanchnic perfusion is associated with increased morbidity and mortality, particularly if liver dysfunction coexists. Heart failure, increased intra-abdominal pressure, haemodialysis and the presence of obstructive sleep apnoea are among the multiple clinical conditions that are associated with impaired splanchnic perfusion in critically ill patients. Total liver blood flow is believed to be relatively protected when gut blood flow decreases, because hepatic arterial flow increases when portal venous flow decreases (the hepatic arterial buffer response [HABR]). However, there is evidence that the HABR is diminished or even abolished during endotoxaemia and when gut blood flow becomes very low. Unfortunately, no drugs are yet available that increase total hepato-splanchnic blood flow selectively and to a clinically relevant extent. The present review discusses old and new concepts of splanchnic vasoregulation from both experimental and clinical viewpoints. Recently published trials in this field are discussed.
Highlights
Under conditions of low systemic blood flow or haemorrhage, perfusion of vital organs is maintained at the expense of perfusion of visceral organs [1,2,3]
We demonstrated that the splanchnic organs are not among the first to produce lactate because fractional splanchnic blood flow is preserved
Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality
Summary
Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. Splanchnic blood flow may become insufficient as a result of a multitude of different diseases and treatment modalities. Splanchnic vasoregulation is complex and is altered by disease and treatment. Many of the available monitoring tools for hepato-splanchnic blood flow and metabolism are difficult to apply in the clinical setting, and interpretation of the results obtained is not straightforward. Concepts of splanchnic resuscitation are not established. Future research projects should focus on the interplay between the physiological regulatory mechanisms in splanchnic organs, disease and treatment
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