• John D Lyons and Craig M Coopersmith.
• Both authors: Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA.
• Pediatr Crit Care Me. 2017 Mar 1; 18 (3_suppl Suppl 1): S46-S49.

ObjectiveTo describe and summarize the data supporting the gut as the motor driving critical illness and multiple organ dysfunction syndrome presented at the National Institute of Child Health and Human Development MODS Workshop (March 26-27, 2015).Data SourcesSummary of workshop keynote presentation.Study SelectionNot applicable.Data ExtractionPresented by an expert in the field, the data assessing the role of gastrointestinal dysfunction driving critical illness were described with a focus on identifying knowledge gaps and research priorities.Data SynthesisSummary of presentation and discussion supported and supplemented by relevant literature.ConclusionsThe understanding of gut dysfunction in critical illness has evolved greatly over time, and the gut is now often considered as the "motor" of critical illness. The association of the gut with critical illness is supported by both animal models and clinical studies. Initially, the association between gut dysfunction and critical illness focused primarily on bacterial translocation into the bloodstream. However, that work has evolved to include other gut-derived products causing distant injury via other routes (e.g., lymphatics). Additionally, alterations in the gut epithelium may be associated with critical illness and influence outcomes. Gut epithelial apoptosis, intestinal hyperpermeability, and perturbations in the intestinal mucus layer have all been associated with critical illness. Finally, there is growing evidence that the intestinal microbiome plays a crucial role in mediating pathology in critical illness. Further research is needed to better understand the role of each of these mechanisms and their contribution to multiple organ dysfunction syndrome in children.

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