Modulation of the Hypermetabolic Response to Trauma: Temperature, Nutrition, and Drugs

Williams, Felicia N.; Jeschke, Marc G.; Chinkes, David L.; Suman, Oscar E.; Branski, Ludwik K.; Herndon, David N.

doi:10.1016/j.jamcollsurg.2009.01.022

Cited by 108 publications

(103 citation statements)

References 128 publications

(191 reference statements)

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“…We emphasize that the disappearance rates of tocopherol were similar for a-and c-tocopherol in each subject (exponential for initial a-tocopherol concentrations .150 nmol/g adipose tissue and constant for those ,150 nmol/g adipose tissue), which suggests a common, rapid depletion mechanism for both tocopherols until minimum tissue concentrations are achieved (Figure 1), whereas the disappearance of the triglyceride clearly differed from that of the tocopherols, which suggests a tocopherol-depletion mechanism independent of that of triglyceride. It is well known that burn patients are in a hypercatabolic state and have an elevated metabolic rate (34) and that depletion of fat stores, massive lipolysis, and the development of fatty liver are all components of the disorder (34). The redistribution of tocopherol as described herein, however, was not previously observed in obese subjects consuming a weight-reduction diet that depleted triglycerides from the adipose tissue (35).…”

Section: Discussionmentioning

confidence: 55%

α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients

Traber¹,

Leonard²,

Traber³

et al. 2010

The American Journal of Clinical Nutrition

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Background: We previously showed that thermal injury depletes plasma vitamin E in pediatric burn patients; however, plasma changes may reflect immediate alterations in vitamin E nutriture. Adipose tissue a-tocopherol concentrations are generally accepted to reflect long-term vitamin E status. Objective: To test the hypothesis that thermal injury depletes body stores of vitamin E, a-tocopherol concentrations were measured in adipose tissue samples. Design: Pediatric patients (n = 8) were followed up to 1 y after burn injury. Surgically obtained samples were collected at various intervals and stored at 280°C in a biorepository. a-and c-Tocopherols, cholesterol, and triglycerides were measured in the same tissue aliquot. Results: During the first week after injury, adipose tissue a-tocopherol concentrations were within the expected normal range of 199 6 40 nmol/g adipose tissue but were substantially lower at weeks 2 and 3 (133 6 13 and 109 6 8 nmol/g adipose tissue, respectively). Individual rates of decrease, estimated by linear regression, showed that adipose tissue a-tocopherol decreased by an average of 6.1 6 0.6 nmol/g daily. During the first month after injury, adipose tissue triglyceride concentrations also decreased, whereas no changes in cholesterol concentrations occurred. Conclusions: These data emphasize that the burn injury experienced by these pediatric patients altered their metabolism such that vitamin E status diminished during the month after injury. Further studies are needed to evaluate the mechanism and consequences of the observed vitamin E depletion. This trial was registered at clinicaltrials.gov as NCT00675714.Am J Clin Nutr 2010;92:1378-84.

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Section: Discussionmentioning

confidence: 55%

α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients

Traber¹,

Leonard²,

Traber³

et al. 2010

The American Journal of Clinical Nutrition

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“…These states, when prolonged, warrant the consideration of the use of partial or total parenteral nutrition (TPN) to meet caloric requirements. 54 With the wide application of glycemic control and safe methods for preparing TPN, some institutions routinely supplement enteral feeds with this method to achieve caloric goals when use of the gut is problematic. 54 The use of a calorie-dense, high carbohydrate to fat ratio enteral feeding formula in patients with burn is associated with best outcomes.…”

Section: What's New?mentioning

confidence: 99%

“…54 Typical burn institutional practice provides children with 2.5 to 3.0 g/kg/d and adults with 1.5 to 2.0 g/kg/d of protein. To maintain a positive nitrogen balance, we recommend measuring urine urea nitrogen and balance weekly.…”

Section: What's New?mentioning

confidence: 99%

Update on Severe Burn Management for the Intensivist

Lundy

Chung

Pamplin

et al. 2016

J Intensive Care Med

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Thermal injury of humans causes arguably the most severe perturbations in physiology that can be experienced. These physiologic derangements start immediately and can persist in some form until months or even years after the burn wounds are healed. Burn shock, marked activation of the systemic inflammatory response, multiple-organ failure, infection, and wound failure are just a few of the insults that may require management by the intensivist. The purpose of this article is to review recent advances in the critical care management of thermally injured patients.

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“…A 10% body mass loss will lead to immune dysfunction; 20% to impaired wound healing; 30%, severe infections and 40%, death 27 .…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

Oxandrolone use in adult burn patients. Systematic review and meta-analysis

et al. 2014

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PURPOSE:This study is a systematic literature review and meta-analysis concerning the use of a testosterone synthetic analog, oxandrolone, and its use in severe adult burns. METHODS:Randomized prospective clinical studies, in English, Portuguese or Spanish, were sought on the following databases:MEDLINE, COCHRANE, EMBASE and LILACS. There was no restriction in relation to the publication date. RESULTS:This search produced 24 studies on MEDLINE and twelve articles were presented on the COCHRANE database .Sixteen were excluded due to the title not being related to this search or by including children. Of the eigth residual studies, after adaptation to the inclusion criteria, only four were selected. After analyzing the results, two were discarded since they did not present adequate patient characterization and the facts on these articles were analyzed differently from the others, hindering the meta-analysis. CONCLUSION:The analysis of the available data demonstrated significant benefits (p<0.05) considering lesser loss of corporal mass, lesser nitrogen loss, and shorter donor area healing time, when Oxandrolone was used, comparatively with the control group (placebo or not).

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Modulation of the Hypermetabolic Response to Trauma: Temperature, Nutrition, and Drugs

Cited by 108 publications

References 128 publications

α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients

α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients

Update on Severe Burn Management for the Intensivist

Oxandrolone use in adult burn patients. Systematic review and meta-analysis

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