A review of metabolic staging in severely injured patients.

Abstract

An interpretation of the metabolic response to injury in patients with severe accidental or surgical trauma is made. In the last century, various authors attributed a meaning to the post-traumatic inflammatory response by using teleological arguments. Their interpretations of this response, not only facilitates integrating the knowledge, but also the flow from the bench to the bedside, which is the main objective of modern translational research. The goal of the current review is to correlate the metabolic changes with the three phenotypes -ischemia-reperfusion, leukocytic and angiogenic- that the patients express during the evolution of the systemic inflammatory response. The sequence in the expression of multiple metabolic systems that becomes progressively more elaborate and complex in severe injured patients urges for more detailed knowledge in order to establish the most adequate metabolic support according to the evolutive phase. Thus, clinicians must employ different treatment strategies based on the different metabolic phases when caring for this challenging patient population. Perhaps, the best therapeutic option would be to favor early hypometabolism during the ischemia-reperfusion phase, to boost the antienzymatic metabolism and to reduce hypermetabolism during the leukocytic phase through the early administration of enteral nutrition and the modulation of the acute phase response. Lastly, the early epithelial regeneration of the injured organs and tissues by means of an oxidative metabolism would reduce the fibrotic sequelae in these severely injured patients.

• Authors: Maria-Angeles Aller, Jose-Ignacio Arias, Alfredo Alonso-Poza, Jaime Arias
• Journal: Scandinavian journal of trauma, resuscitation and emergency medicine (Scand J Trauma Resusc Emerg Med) Vol. 18 Pg. 27 (May 17 2010) ISSN: 1757-7241 [Electronic] England
• PMID: 20478066 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Topics

• Humans
• Systemic Inflammatory Response Syndrome (metabolism)
• Trauma Severity Indices
• Wounds and Injuries (metabolism)