Animal studies of acute disease show that lymph fluid draining from the gut causes inflammation and failure of vital end organs, such as the heart, lungs and kidneys. To test this in clinical studies we must establish a reliable minimally invasive technique for inserting a drainage tube into the thoracic duct to collect lymph. This project will allow, for the first time, composition and toxicity studies of human lymph during acute disease and uses our established analytical methods. Then we will conduct a randomised control trial to test external drainage of this lymph in patients with severe acute diseases with the aim of reducing inflammation and organ dysfunction and improving clinical outcome. This is an essential project to confirm the role of gut lymph in driving severe acute disease in patients and to allow future testing of new treatment strategies.