Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma
Understanding the changes in energy expenditure and body composition is essential for the optimal management of the critically injured, yet these changes have not been quantified within the current context of trauma care. Ten critically injured patients (median Injury Severity Score = 35) had measur...
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| Veröffentlicht in: | Annals of surgery 1996-04, Vol.223 (4), p.395-405 |
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| container_title | Annals of surgery |
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| creator | MONK, D. N PLANK, L. D FRANCH-ARCAS, G FINN, P. J STREAT, S. J HILL, G. L |
| description | Understanding the changes in energy expenditure and body composition is essential for the optimal management of the critically injured, yet these changes have not been quantified within the current context of trauma care.
Ten critically injured patients (median Injury Severity Score = 35) had measurements of energy expenditure and body composition as soon as they were hemodynamically stable and then every 5 days for 21 days.
Resting energy expenditure rose to 55% above predicted and remained elevated throughout the study period. Total energy expenditure was 1.32 X resting energy expenditure. Body fat was oxidized when energy intake was insufficient (r=-0.830, p |
| doi_str_mv | 10.1097/00000658-199604000-00008 |
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Ten critically injured patients (median Injury Severity Score = 35) had measurements of energy expenditure and body composition as soon as they were hemodynamically stable and then every 5 days for 21 days.
Resting energy expenditure rose to 55% above predicted and remained elevated throughout the study period. Total energy expenditure was 1.32 X resting energy expenditure. Body fat was oxidized when energy intake was insufficient (r=-0.830, p<0.02). Body water changes closely paralleled body weight changes and were largely accounted for by changes in extracellular water. Over the 21-day study period, there was a loss of 1.62 kg (16%) of total body protein (p<0.0002), of which 1.09 kg (67%) came from skeletal muscle. Intracellular potassium was low (133 +/- 3 mmol/L, p<0.02) but did not deteriorate further after hemodynamic stability had been reached.
These results show that the period of hypermetabolism lasts longer and the protein loss is greater in critically injured patients than previously thought. Most, but not all, the protein is lost from muscle. Fat loss can be prevented and cell composition preserved once hemodynamic stability is achieved.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/00000658-199604000-00008</identifier><identifier>PMID: 8633918</identifier><identifier>CODEN: ANSUA5</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Biological and medical sciences ; Body Composition ; Body Water - metabolism ; Critical Illness ; Energy Metabolism ; Humans ; Medical sciences ; Multiple trauma ; Muscle, Skeletal - metabolism ; Oxygen Consumption ; Prospective Studies ; Proteins - metabolism ; Stress, Physiological - metabolism ; Traumas. Diseases due to physical agents ; Wounds, Nonpenetrating - metabolism</subject><ispartof>Annals of surgery, 1996-04, Vol.223 (4), p.395-405</ispartof><rights>1996 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-aecf294530e07290f14b16b2c16ac8a369e18bb73c225c264cd7772ca70092543</citedby><cites>FETCH-LOGICAL-c510t-aecf294530e07290f14b16b2c16ac8a369e18bb73c225c264cd7772ca70092543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1235135/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1235135/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3059702$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8633918$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MONK, D. N</creatorcontrib><creatorcontrib>PLANK, L. D</creatorcontrib><creatorcontrib>FRANCH-ARCAS, G</creatorcontrib><creatorcontrib>FINN, P. J</creatorcontrib><creatorcontrib>STREAT, S. J</creatorcontrib><creatorcontrib>HILL, G. L</creatorcontrib><title>Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>Understanding the changes in energy expenditure and body composition is essential for the optimal management of the critically injured, yet these changes have not been quantified within the current context of trauma care.
Ten critically injured patients (median Injury Severity Score = 35) had measurements of energy expenditure and body composition as soon as they were hemodynamically stable and then every 5 days for 21 days.
Resting energy expenditure rose to 55% above predicted and remained elevated throughout the study period. Total energy expenditure was 1.32 X resting energy expenditure. Body fat was oxidized when energy intake was insufficient (r=-0.830, p<0.02). Body water changes closely paralleled body weight changes and were largely accounted for by changes in extracellular water. Over the 21-day study period, there was a loss of 1.62 kg (16%) of total body protein (p<0.0002), of which 1.09 kg (67%) came from skeletal muscle. Intracellular potassium was low (133 +/- 3 mmol/L, p<0.02) but did not deteriorate further after hemodynamic stability had been reached.
These results show that the period of hypermetabolism lasts longer and the protein loss is greater in critically injured patients than previously thought. Most, but not all, the protein is lost from muscle. Fat loss can be prevented and cell composition preserved once hemodynamic stability is achieved.</description><subject>Biological and medical sciences</subject><subject>Body Composition</subject><subject>Body Water - metabolism</subject><subject>Critical Illness</subject><subject>Energy Metabolism</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Multiple trauma</subject><subject>Muscle, Skeletal - metabolism</subject><subject>Oxygen Consumption</subject><subject>Prospective Studies</subject><subject>Proteins - metabolism</subject><subject>Stress, Physiological - metabolism</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Wounds, Nonpenetrating - metabolism</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUctuFDEQtBBRWAKfgOQD4jbg59i-IKGIlxSJQ5Kz1ePx7DryeBbbA9q_x5ssK_DF6qrq6lYXQpiS95QY9YEcXy91R43piWhFd0T0M7ShkjWYCvIcbRrEO2E4e4FelvJACBWaqEt0qXvODdUb9PvW_1x9qgEidjtIW19wSLjuPJ59hWGJweHsy35JxR8Zl0MNDmI8tOphzX7Ee6ihWRQ8rjmk7WPzFHKpmEk8wqFgmKrPeIhrqrhmWGd4hS4miMW_Pv1X6P7L57vrb93Nj6_frz_ddE5SUjvwbmJGSE48UcyQiYqB9gNztAengffGUz0MijvGpGO9cKNSijlQhBgmBb9CH5989-sw-9G1PTNEu89hhnywCwT7P5PCzm6XX5YyLimXzeDdySAv7VKl2jkU52OE5Je1WKXbkUXPmlA_CV1eSsl-Og-hxB5Ds39Ds-fQHiHdWt_8u-S58ZRS49-eeCjt9FOG5EI5yziRRhHG_wDzmaE4</recordid><startdate>19960401</startdate><enddate>19960401</enddate><creator>MONK, D. N</creator><creator>PLANK, L. D</creator><creator>FRANCH-ARCAS, G</creator><creator>FINN, P. J</creator><creator>STREAT, S. J</creator><creator>HILL, G. L</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19960401</creationdate><title>Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma</title><author>MONK, D. N ; PLANK, L. D ; FRANCH-ARCAS, G ; FINN, P. J ; STREAT, S. J ; HILL, G. L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-aecf294530e07290f14b16b2c16ac8a369e18bb73c225c264cd7772ca70092543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Biological and medical sciences</topic><topic>Body Composition</topic><topic>Body Water - metabolism</topic><topic>Critical Illness</topic><topic>Energy Metabolism</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Multiple trauma</topic><topic>Muscle, Skeletal - metabolism</topic><topic>Oxygen Consumption</topic><topic>Prospective Studies</topic><topic>Proteins - metabolism</topic><topic>Stress, Physiological - metabolism</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Wounds, Nonpenetrating - metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MONK, D. N</creatorcontrib><creatorcontrib>PLANK, L. D</creatorcontrib><creatorcontrib>FRANCH-ARCAS, G</creatorcontrib><creatorcontrib>FINN, P. J</creatorcontrib><creatorcontrib>STREAT, S. J</creatorcontrib><creatorcontrib>HILL, G. L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MONK, D. N</au><au>PLANK, L. D</au><au>FRANCH-ARCAS, G</au><au>FINN, P. J</au><au>STREAT, S. J</au><au>HILL, G. L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>1996-04-01</date><risdate>1996</risdate><volume>223</volume><issue>4</issue><spage>395</spage><epage>405</epage><pages>395-405</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><coden>ANSUA5</coden><abstract>Understanding the changes in energy expenditure and body composition is essential for the optimal management of the critically injured, yet these changes have not been quantified within the current context of trauma care.
Ten critically injured patients (median Injury Severity Score = 35) had measurements of energy expenditure and body composition as soon as they were hemodynamically stable and then every 5 days for 21 days.
Resting energy expenditure rose to 55% above predicted and remained elevated throughout the study period. Total energy expenditure was 1.32 X resting energy expenditure. Body fat was oxidized when energy intake was insufficient (r=-0.830, p<0.02). Body water changes closely paralleled body weight changes and were largely accounted for by changes in extracellular water. Over the 21-day study period, there was a loss of 1.62 kg (16%) of total body protein (p<0.0002), of which 1.09 kg (67%) came from skeletal muscle. Intracellular potassium was low (133 +/- 3 mmol/L, p<0.02) but did not deteriorate further after hemodynamic stability had been reached.
These results show that the period of hypermetabolism lasts longer and the protein loss is greater in critically injured patients than previously thought. Most, but not all, the protein is lost from muscle. Fat loss can be prevented and cell composition preserved once hemodynamic stability is achieved.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>8633918</pmid><doi>10.1097/00000658-199604000-00008</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Annals of surgery, 1996-04, Vol.223 (4), p.395-405 |
| issn | 0003-4932 1528-1140 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Biological and medical sciences Body Composition Body Water - metabolism Critical Illness Energy Metabolism Humans Medical sciences Multiple trauma Muscle, Skeletal - metabolism Oxygen Consumption Prospective Studies Proteins - metabolism Stress, Physiological - metabolism Traumas. Diseases due to physical agents Wounds, Nonpenetrating - metabolism |
| title | Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma |
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