Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients: From Molecular to Clinical Outcomes

Abstract

The critically ill polytrauma patient is characterized by a series of metabolic changes induced by inflammation, oxidative stress, sepsis, and primary trauma, as well as associated secondary injuries associated. Metabolic and nutritional dysfunction in the critically ill patient is a complex series of imbalances of biochemical and genetic pathways, as well as the interconnection between them. Therefore, the equation changes in comparison to other critical patients or to healthy individuals, in which cases, mathematical equations can be successfully used to predict the energy requirements. Recent studies have shown that indirect calorimetry is one of the most accurate methods for determining the energy requirements in intubated and mechanically ventilated patients. Current research is oriented towards an individualized therapy depending on the energy consumption (kcal/day) of each patient that also takes into account the clinical dynamics. By using indirect calorimetry, one can measure, in real time, both oxygen consumption and carbon dioxide production. Energy requirements (kcal/day) and the respiratory quotient (RQ) can be determined in real time by integrating these dynamic parameters into electronic algorithms. In this manner, nutritional therapy becomes personalized and caters to the patients’ individual needs, helping patients receive the energy substrates they need at each clinically specific time of treatment.

Evaluation of the association between plasma glucose-dependent insulinotropic polypeptide, respiratory quotient, and intramuscular fat deposition in feedlot cattle fed different levels of dry matter intake

“…The main responses of GIP in non-ruminants are stimulating insulin secretion and to increase fat accumulation ( Dupre et al, 1973 ; Martin and Faulkner, 1993 ; Miyawaki et al, 2002 ; Yamane et al, 2016 ). The steers in both groups had lesser RQ before feeding at approximately 0.7 which could indicate that fat was used as an energy substrate ( Rogobete et al, 2019 ). Nonetheless, RQ results before and after feeding were approximately 0.7 which mean they were still using mainly fat as a substrate.…”

The Impact of General Anesthesia on Redox Stability and Epigenetic Inflammation Pathways: Crosstalk on Perioperative Antioxidant Therapy

“…Another site for excessive ROS production is the alveolar macrophage. The reperfusion phase is characterized by pro-inflammatory cytokine release, the activation of NOS, and neutrophile recruitment [ 73 , 74 , 75 , 76 , 77 , 78 ] ( Figure 1 ).…”

Risk factors for malnutrition among hospitalized gastroenterological patients

“…Severe disease activity is thought to cause increased nutritional requirements due to stress metabolism. [31][32] Therefore, many authors agree that the risk of intrahospital malnutrition correlates with the severity of the disease and that malnutrition is more pronounced in advanced stages of the disease. 13,29,33,34 There is no doubt regarding the association between malignant disease and nutritional status.…”