Regional contribution to hypermetabolism following trauma

Abstract

Severe injuries are associated with a systemic inflammatory response. This inflammatory response is qualitatively similar in trauma and sepsis, and its magnitude depends on the severity of the inflammatory stimulus. The hypermetabolism induced by injury does not affect the whole body uniformly. The splanchnic region appears to be the main source of the hypermetabolic response in various types of trauma and inflammation. The increased splanchnic metabolic activity is not fully matched by concomitant increases in blood flow. This mismatch of metabolic demand and blood flow increase the risk of inadequate tissue perfusion in the splanchnic region. In the acute phase of injury this risk is magnified by the common presence of inadequate blood volume during the resuscitation from trauma. Hypovolaemia-induced splanchnic vasoconstriction persists even after correction of the hypovolaemia, which further increases the risk of inadequate perfusion of the splanchnic bed. Splanchnic hypermetabolism explains most of the hypermetabolic response to injury.