Surgical Research: Energy and Protein Metabolism in Sepsis and Trauma

Abstract

Energy and protein metabolism in septic and trauma patients has been extensively studied over the past 30 years. Despite this, a number of inconsistencies are present in the literature and it is difficult to formulate a clear global picture of this complex series of metabolic events. Conclusions from human studies have often been hampered by the utilization of small numbers of patients, and data from animal models of sepsis or trauma are often difficult to interpret. Over the past 5 years, the authors have performed a series of isotopic infusions in normal volunteers, and in patients with either sepsis or trauma, in order to gain a clearer understanding of energy and protein metabolism in severely stressed patients. This review summarizes the findings.

Review article: intestinal failure

“…However, it is worth reiterating that resolution of sepsis is a fundamental requirement for replenishing and maintaining adequate nutritional status. It has been shown that despite the provision of adequate nitrogen and caloric requirement in excess of metabolic expenditure, septic patients will remain catabolic and continue to lose substantial amounts of protein 40 …”

Evaluation of an Artificial Neural Network to Predict Urea Nitrogen Appearance for Critically Ill Multiple‐Trauma Patients

“…The impact of modulating this loss with conventional specialized nutrition support in traumatized and septic patients has been only modestly effective; however, it is clearly better to provide specialized nutrition support than commonly used IV dextrose-containing crystalloid fluids alone. 3,4,26,27 Despite their limitations, nitrogen balance and UNA are common methods used in clinical practice to assess the extent of protein catabolism and to evaluate the efficacy of a specialized nutrition support regimen. UNA.…”

“…Although conventional nutrition support does not totally ameliorate net protein catabolism, protein catabolism is reduced with nutrition intervention. 3,4 Therefore, it would be important to accurately identify which patients are most likely to experience marked protein catabolism and implement aggressive early nutrition intervention in those patients.…”

Body Composition, Physiological Function and Psychological Changes in Patients with Predicted Severe Acute Pancreatitis

“…In sepsis, there are markedly elevated rates of net protein breakdown and hypercatabolism which are only minimally reduced with aggressive nutritional support. These findings are based on work performed on 8 patients with severe sepsis (1 of whom had pancreatic abscess formation) and who were not protein depleted at the time of their first body composition assessment [8]. However, they lost mean (SD) 1.5 (0.3) kg of protein over a 10-day period.…”