Gut oxygenation in sepsis: Still a matter of controversy?

Part of Stephan Jakob's exhaustive review paper in the present issue of Critical Care deals with the notion that intestinal cellular energetics are deranged in sepsis, in terms not only of inadequate tissue perfusion but also of impaired mitochondrial respiration and/or coupling (i.e. organ dysfunction in sepsis may occur as a result of 'cytopathic hypoxia'). This suggests that efforts to improve outcome in septic patients by manipulating systemic oxygen delivery and regional blood flow are doomed to failure. That suggestion remains largely speculative, and experimental and clinical results presented here consistently demonstrate that there is still a place for treatment of abnormal perfusion in the context of early severe sepsis and septic shock.