Aller et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010, 18:27
A Review of metabolic staging in severely injured patients
Maria-Angeles Aller1, Jose-Ignacio Arias*2, Alfredo Alonso-Poza3 and Jaime Arias1
Abstract An interpretation of the metabolic response to injury in patients with severe accidental or surgical trauma ismade. In the last century, various authors attributed a meaning to the post-traumatic inflammatory response by using teleological arguments. Their interpretations of this response, not only facilitates integrating the knowledge, but also the flow from the bench to the bedside, which is the main objective of modern translational research. The goal of the current review is to correlate the metabolicchanges with the three phenotypes -ischemia-reperfusion, leukocytic and angiogenic- that the patients express during the evolution of the systemic inflammatory response. The sequence in the expression of multiple metabolic systems that becomes progressively more elaborate and complex in severe injured patients urges for more detailed knowledge in order to establish the most adequate metabolic supportaccording to the evolutive phase. Thus, clinicians must employ different treatment strategies based on the different metabolic phases when caring for this challenging patient population. Perhaps, the best therapeutic option would be to favor early hypometabolism during the ischemia-reperfusion phase, to boost the antienzymatic metabolism and to reduce hypermetabolism during the leukocytic phasethrough the early administration of enteral nutrition and the modulation of the acute phase response. Lastly, the early epithelial regeneration of the injured organs and tissues by means of an oxidative metabolism would reduce the fibrotic sequelae in these severely injured patients. Introduction Inflammation is a complex, multiscale biologic response to stress that is also required for repair andregeneration after injury . Particularly, in patients with severe accidental or surgical trauma the inflammatory response shows its multifaceted and actually soundless capacity . In the last century, David P. Cuthbertson , Hans Selye  and Francis D. Moore  attributed a meaning to the post-traumatic inflammatory response accordingly with previous discoveries and the knowledge of thetime. By using teleological arguments, these extraordinary authors tried to make inroads into the understanding of the metabolic response of the body to injury [6-8]. Their interpretations of this response, not only facilitates integrating the knowledge, but also the flow from the bench to the bedside, which is the main objective of modern translational research [1,9,10].
Thus, this would justify the contribution of new interpretations of the metabolic response to injury, in an attempt to facilitate incorporating the newly acquired knowledge of these conditions, in addition to other apparently disparate diseases that have common biological pathways and therapeutic approaches .
Trophic mechanisms linked to the evolution ofthe Inflammatory Response
General and Digestive Surgery Unit, Monte Naranco Hospital, Consejeria de Salud y Servicios Sanitarios, Principado de Asturias, Oviedo, Spain
Full list of author information is available at the end of the article
We have formulated the hypothesis that both acute local and systemic inflammatory response to injury are based on the successive pathologic functionalpredominance of three systems referred to as the nervous, inmune and endocrine systems. These names are based on the idea that the final and prevalent functions traditionally attributed to these systems may represent the consecutive response phases to stress [11-13]. This hypothesis implies that the successive pathophysiological mechanisms developed by the body when undergoing inflammation are...
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