Chapter 1 Metabolic response to injury

The role of surgical critical care, including resuscitation and/ or organ support, must be to work alongside the metabolic effects of injury while the patient is restored to a situation from which homeostatic mechanisms can achieve a return to normality. Impaired immunity as part of the metabolic response compounds this risk and explains why sepsis and MODS/ failure is a key part of perioperative care and a leading mode of death among our patients. This chapter reviews the mediators of the stress response, the physiological and biochemical pathway changes associated with surgical injury and the changes in body composition that occur following surgical injury. Patients also respond rapidly to injury by the classical neuroendocrine pathways of the stress response, consisting of afferent nociceptive neurones, the spinal cord, thalamus, hypothalamus and pituitary.

Multiple Choice Questions
Weblinks

Journal articles

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342478/ (free)

Paper describing the effects of using b-blocker to block the adrenergic hyperactivation that drives adverse stress responses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105702/ (free)

Review article summarising current knowledge on the roles of inflammasomes and damage-associated molecular patterns (DAMPs) in trauma.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078999/ (free)

Contemporary human study on multiple organ dysfunction syndrome (MODS) subtypes in trauma critical care at a population level. Describes incidence of MODS, patterns of severity and recovery, their admission characteristics.

https://www.clinicalnutritionjournal.com/article/S0261-5614(05)00023-3/fulltext/ (paid)

Seminal consensus review article describing enhanced recovery after surgery (ERAS) for patients undergoing colonic resection but with broader clinical applications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6027646/ (free)

Review describing responses to trauma in relation to chest, abdomen and head injury, plus the endothelium as a ‘meta-organ’, and their interrelated changes in innate immunity after trauma.

https://academic.oup.com/jcem/article/95/9/4217/2835313/ (free)

Authoritative editorial on insulin resistance and surgical outcomes, insulin resistance being one of the most fundamental reactions to injury and stress.

https://jamanetwork.com/journals/jamasurgery/fullarticle/2595921/ (free)

Authoritative review of impact of enhanced recovery after surgery (ERAS) as an evidence-based care improvement process for surgical patients, describing major improvements in clinical outcomes and cost.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693769/ (free)

Study of incidence and risk factors of chronic critical illness (CCI) after severe blunt trauma. CCI is defined as an ICU stay lasting ≥14 days with evidence of persistent organ dysfunction.

https://www.nature.com/articles/ncpendmet0071/ (paid)

Review article describing the endocrine aspects of acute and prolonged critical illness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013556/ (free)

Review summarising current knowledge regarding damage-associated molecular pattern (DAMP)-mediated systemic inflammatory response syndrome (SIRS) or immunosuppression and the clinical consequences in terms of organ failure and infections.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422623/ (free) Classic and authoritative review of surgical and traumatic stress, pathways and outcomes.

  Back To TopTo top