Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Oct 4:1:29.
doi: 10.1186/1749-7922-1-29.

Metabolic changes after polytrauma: an imperative for early nutritional support

Erik Hasenboehler  1 , Allison Williams, Iris Leinhase, Steven J Morgan, Wade R Smith, Ernest E Moore, Philip F Stahel
Affiliations

Metabolic changes after polytrauma: an imperative for early nutritional support

Erik Hasenboehler et al. World J Emerg Surg. .

Abstract

Major trauma induces marked metabolic changes which contribute to the systemic immune suppression in severely injured patients and increase the risk of infection and posttraumatic organ failure. The hypercatabolic state of polytrauma patients must be recognized early and treated by an appropriate nutritional management in order to avoid late complications. Clinical studies in recent years have supported the concept of "immunonutrition" for severely injured patients, which takes into account the supplementation of Omega-3 fatty acids and essential aminoacids, such as glutamine. Yet many aspects of the nutritional strategies for polytrauma patients remain controversial, including the exact timing, caloric and protein amount of nutrition, choice of enteral versus parenteral route, and duration. The present review will provide an outline of the pathophysiological metabolic changes after major trauma that endorse the current basis for early immunonutrition of polytrauma patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Denver Health Medical Center institutional protocol for early enteral nutrition of severely injured patients. Adapted from: [39]. Abbreviations: ABGA, arterial blood gas analysis; ATI, Abdominal Trauma Index; CBC, complete blood count; HR, heart rate; ETF, enteral tube feeding; IAP, intraabdominal pressure (bladder pressure); ISS, Injury Severity Score; MAR, medicine administration record; NCJ, needle catheter jejunostomy; PEG, percutaneous endoscopic gastrostomy; PRBC, packed red blood cells. * Monitoring of IAP for high risk patients with severe pelvic ring injuries, lumbar spine fractures, polytrauma with ISS > 17, hemorrhagic shock with > 6 units PRBC in 12 h. ** In massively injured patients (ISS>40, ATI>40, PRBC mass transfusions), administer low dose enteral feeding (15–30 ml/h) for the first 3 days due to anticipated intolerance to full-dose enteral feeding. Advance per protocol on the 4th day post injury.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Plank LD, Hill GL. Energy balance in critical illness. Proc Nutr Soc. 2003;62:545–552. doi: 10.1079/PNS2003259. - DOI - PubMed
    1. Griffiths RD, Hinds CJ, Little RA. Manipulating the metabolic response to injury. Brit Med Bull. 1999;55:181–195. doi: 10.1258/0007142991902204. - DOI - PubMed
    1. Keel M, Trentz O. Pathophysiology of polytrauma. Injury. 2005;36:691–709. doi: 10.1016/j.injury.2004.12.037. - DOI - PubMed
    1. Schlag G, Redl H. Mediators of injury and inflammation. World J Surg. 1996;20:406–410. doi: 10.1007/s002689900064. - DOI - PubMed
    1. Redl H, Bahrami S, Fürst W, Schiesser A, Schlag G, Mollnes TE. Evidence for early bacteremia/endotoxemia and inflammatory responses after trauma: hemorrhage and complement activation in a nonhuman primate model. Eur J Trauma. 2000;26:300–307. doi: 10.1007/PL00002455. - DOI

LinkOut - more resources