The Polytraumatized Patient

Pp: 154-179 (26)

* (Excluding Mailing and Handling)

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 theleological arguments. Their interpretations of this response, not only facilitate integrating the knowledge, but also their 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 through 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.

Keywords: Inflammation, trauma, metabolic response, shock, hypothalamicpituitary- adrenal axis, ebb phase, flow phase, acidosis, immunonutrition, metabolic staging, anaerobic glycolysis.