General Metabolism in Patients with Acute Paraplegia and Quadriplegia

Abstract

This study measured the nutritional status of eight spine-injured patients during their first 10 to 14 days in the hospital. Initial and follow-up nutritional assessment showed that their nutritional status deteriorated at least partly due to an inadequate supply of protein and calories. Infective complications and prolonged respiratory support were common and may have been caused in part by impaired nutrition. This suggests that a prospective study of aggressive nutritional support for patients with spinal cord transection should be initiated to determine whether this acquired malnutrition and its associated complications can be prevented.

The metabolic response to spinal cord injury

“…However, it was not speci®ed by these investigators how protein needs were estimated or if these needs were being met at the time of NB determinations. 20 When Kolpek et al compared UUN excretions by seven acute SCI patients to seven head trauma patients, similar results were observed. In their SCI group, peak negative NB was observed during week 3 despite adequate delivery of predicted and measured calories.…”

Nutritional Support After Spinal Cord Injury

“…[1][2][3][4][5][6][7] A well-documented hypermetabolic, catabolic injury cascade is initiated immediately after central nervous system injury, which results in depletion of whole body energy stores, loss of lean muscle mass, reduced protein synthesis, and ultimately in loss of gastrointestinal mucosal integrity and compromise of immune competence. 2,3,[5][6][7][8][9] Severely injured brain and spinal cord injury patients, therefore, are at risk for prolonged nitrogen losses and advanced malnutrition within 2 to 3 weeks following injury with resultant increased susceptibility for infection, impaired wound healing, and difficulty weaning from mechanical ventilation.…”

“…2,3,[5][6][7][8][9] Severely injured brain and spinal cord injury patients, therefore, are at risk for prolonged nitrogen losses and advanced malnutrition within 2 to 3 weeks following injury with resultant increased susceptibility for infection, impaired wound healing, and difficulty weaning from mechanical ventilation. [3][4][5][6][7]10 These factors added to the inherent immobility, denervation, and muscle atrophy associated with spinal cord injury provide the rationale for nutritional support of spinal cord injured patients following trauma. The guidelines author group of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons provided a medical evidence-based guideline on this topic in 2002.…”

“…1,3,5,7,9,[12][13][14][15] Fewer studies have focused on hypermetabolism, catabolism, and nitrogen losses following acute SCI. 4,7,10,16,17 While there are metabolic similarities between isolated traumatic brain injury and severely isolated SCI, it appears there may be important biological differences between the 2 central nervous system (CNS) injury types that have bearing on supplemental nutritional therapy. [4][5][6][7][8]16,17 Severe head injury is associated with a resting energy expenditure (REE) of approximately 140% of predicted normal basal energy expenditure 3,5,7,[12][13][14][15] Indirect calorimetry is the most widely used reliable means to determine individual energy requirements in hospitalized patients after traumatic injury.…”

“…4,7,10,16,17 While there are metabolic similarities between isolated traumatic brain injury and severely isolated SCI, it appears there may be important biological differences between the 2 central nervous system (CNS) injury types that have bearing on supplemental nutritional therapy. [4][5][6][7][8]16,17 Severe head injury is associated with a resting energy expenditure (REE) of approximately 140% of predicted normal basal energy expenditure 3,5,7,[12][13][14][15] Indirect calorimetry is the most widely used reliable means to determine individual energy requirements in hospitalized patients after traumatic injury. 3,[5][6][7] It requires the use of a portable metabolic cart and employs a technique that measures respiratory gas exchange and the rate of oxygen utilization in a given patient.…”