The Polytraumatized Patient
Pp. 154-179 (26)
Maria-Angeles Aller, Jose-Ignacio Arias, Laureano Lorente, Isabel Prieto, Alfredo Alonso-Poza and Jaime Arias
An interpretation of the metabolic response to injury in patients with severe
accidental or surgical trauma is made. In the last century, various authors attributed a
meaning to the post-traumatic inflammatory response by using theleological arguments.
Their interpretations of this response, not only facilitate integrating the knowledge, but
also their 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 metabolic
changes with the three phenotypes -ischemia-reperfusion, leukocytic and angiogenic
that the patients express through 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 support according
to the evolutive phase.
Inflammation, trauma, metabolic response, shock, hypothalamicpituitary-
adrenal axis, ebb phase, flow phase, acidosis, immunonutrition,
metabolic staging, anaerobic glycolysis.
Cátedra de Cirugía, Facultad de Medicina, Universidad Complutense, Pza. de Ramón y Cajal s.n., 28040 MADRID, Spain.