Translocation and multiple organ failure

Translocation of bacteria and endotoxin to mesenteric lymph nodes or portal and venous blood has been demonstrated in animal models of gut ischemia and hemorrhagic shock, but the situation is more complex in humans. Translocation certainly occurs, but it has been associated with systemic symptoms in only one case report involving deliberate ingestion of Candida. In no other study has it been possible to establish a causal link between an acute precipitating illness, translocation, and remote organ injury. Indeed, there is a growing body of evidence which tends to disprove the theory. Studies of patients undergoing laparotomy for blunt trauma have failed to identify portal or systemic endotoxemia or elevation of tumor necrosis factor. Selective antibiotic decontamination of the gut may reduce systemic endotoxemia but has no significant effect on survival. Patients undergoing cardiopulmonary bypass demonstrate gut mucosal ischemia, hyperpermeability, and systemic endotoxemia, but these appear to be independent phenomena. Therefore it is possible that translocation could be a normal process in health or an epiphenomenon in critical illness.

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