Figure 2.

Theoretical framework to maintain intestinal barrier dysfunction in pARDS. EN, enteral nutrition; SIRS, systemic inflammatory response syndrome; CARS, compensatory anti-inflammatory response syndrome. Primary determinants of intestinal barrier function are the apical tight junction complex and the intestinal epithelial cells. Modifiable clinical factors known to modulate intestinal barrier function include EN and antimicrobials. Specific targets for perfusion and oxygenation to improve intestinal barrier function in the setting of pARDS are unknown. The balance of forces will lead to intestinal barrier (A) function or (B) dysfunction and a downstream clinical phenotype with either improved or worsened remote organ (lung) function.