All the inotropes described above have been studied with regard to their effect on the splanchnic circulation. Gastric mucosal pH can be measured using nasogastric probes and is thought to be a marker of perfusion in this particular vascular bed. A fall in gastric mucosal pH indicates vasoconstriction and reduced perfusion. Compromised perfusion allows breakdown of the mucosal barrier, and gut bacteria pass into the portal circulation. Bacteria and endotoxin come into direct contact with Kupffer cells in the liver, stimulating cytokine production and release. These mediators spill over into the systemic circulation and lead to organ dysfunction. This theory has been demonstrated in animal studies, but the role of bacterial gut translocation in the development of multiple organ failure in humans is still an area of research. There is a great interest in nutrition, immunonutrition, and the effects of various vasoactive drugs on the splanchnic circulation for this reason.
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