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Báo cáo y học: " "Metabolic staging" after major trauma - a guide for clinical decision making?"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: "Metabolic staging" after major trauma - a guide for clinical decision making? | Stahel et al. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 2010 18 34 http www.sjtrem.eom content 18 1 34 SCANDINAVIAN JOURNAL OF Et emergency medicine COMMENTARY Open Access Metabolic staging after major trauma - a guide for clinical decision making Philip F Stahel 1 Michael A Flierl1 and Ernest E Moore2 Abstract Metabolic changes after major trauma have a complex underlying pathophysiology. The early posttraumatic stress response is associated with a state of hyperinflammation with increased oxygen consumption and energy expenditure. This hypercatabolic state must be recognized early and mandates an early nutritional management strategy. A proactive concept of early enteral immunonutrition in severely injured patients is aimed at counterbalancing the negative aspects of hyperinflammation and hypercatabolism in order to reduce the risk of late complications including infections and posttraumatic organ failure. Recently the concept of metabolic staging has been advocated which takes into account the distinct inflammatory phases and metabolic phenotypes after major trauma including the ischemia reperfusion phenotype the leukocytic phenotype and the angiogenic phenotype . The potential clinical impact of metabolic staging and of an appropriately adapted metabolic control and nutritional support remains to be determined. Commentary In a recent article published in the Journal Aller and colleagues propose a modern perspective on the metabolic events associated with the inflammatory response to major trauma which should guide therapeutic strategies 1 . The authors classified the metabolic changes after injury into three distinct phenotypes 1 the ischemia reperfusion phenotype 2 the leukocytic phenotype and 3 the angiogenic phenotype . Using this innovative classification concept the authors explain the metabolic alterations in association with the classical progression of posttraumatic inflammation. The first ischemia rep-erfusion phenotype .