NUTRITION AND MULTIPLE ORGAN DYSFUNCTION SYNDROME

Multiple organ dysfunction syndrome (MODS) is seen with increasing frequency in intensive care units as a result of our ability to support single-organ systems and prolong survival in patients with severe illness. One hypothesis of MODS is that altered intestinal permeability during periods of stress allows translocation of bacteria and endotoxin to sterile tissues, thereby initiating this inflammatory process. Nutritional therapy aims to maintain gastrointestinal structure and function to prevent translocation and allow absorption and metabolism of nutrients. Organ-specific nutrient therapy for the gut includes supplementation of either enteral or parenteral formulas with glutamine, arginine, specific fatty acids, and fiber. Ideally, these nutrients would provide stimulus to the gut mucosa to preserve important immune and barrier function as well as modulate the host's immune response to limit cytokine toxicity.