 Commentary"Metabolic staging" after major trauma - a guide for clinical decision making?Philip F Stahel1  , Michael A Flierl1  and Ernest E Moore2 1
Department of Orthopaedic Surgery Denver Health Medical Center University of Colorado School of Medicine 777 Bannock Street Denver, CO 80204 USA 2
Department of Surgery Denver Health Medical Center University of Colorado School of Medicine 777 Bannock Street Denver, CO 80204 USA  author email corresponding author email
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010,
18:34doi:10.1186/1757-7241-18-34 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. | 
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