Metabolic Response and Nutritional Support in Trauma Care

Abstract

After stabilisation and fracture treatment of the trauma patient, adequate nutritional support becomes very important. Traumatic injury induces a stress response that requires large amounts of nutrients. When the provision of substrates is inadequate, endogenous sources like muscle tissue and visceral structures are consumed. This hypercatabolic state makes the trauma patient prone for developing complications. Ultimately, multiple organ failure may develop and the patient becomes critically ill. The metabolic response during critical illness consists of protein catabolism to mobilise amino acids that are needed as substrate for healing tissues, synthesis of acute phase proteins and glucose in the liver. This protein breakdown results in a loss of nitrogen. In addition, glucose production in critically ill patients increases, whereas the ability to utilise glucose is decreased because of insulin resistance. These metabolic responses are necessary for recovery of the trauma patient. In order to prevent “auto-consumption” of protein sources and thereby the development of critical illness, exogenous provision of substrates is necessary. This manuscript summarises important issues like the metabolic response to trauma, early enteral feeding and the role of the gut during critical illness.

Metabolism - nutritional support - trauma - critical illness

References

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