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. 2009 Apr;208(4):489-502.
doi: 10.1016/j.jamcollsurg.2009.01.022.

Modulation of the hypermetabolic response to trauma: temperature, nutrition, and drugs

Felicia N Williams  1 , Marc G Jeschke, David L Chinkes, Oscar E Suman, Ludwik K Branski, David N Herndon
Affiliations

Modulation of the hypermetabolic response to trauma: temperature, nutrition, and drugs

Felicia N Williams et al. J Am Coll Surg. 2009 Apr.
No abstract available

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Figures

Figure 1
Figure 1
Physiologic and metabolic changes post severe burn injury. Demonstrates changes in resting energy expenditure, stress hormones (epinephrine), cardiac function (cardiac output), gender hormones (testosterone), cytokines (interleukin-6) and changes in body composition (lean body mass). Data were summarized from published works from our institution., Averages for burn patients are represented by solid curves. Values from nonburned, normal patients are represented by dashed lines (—).
Figure 2
Figure 2
Effect of burn size on body mass, resting energy expenditure, and protein degradation. Changes in net protein balance of muscle protein synthesis and breakdown induced by burn injury was measured by stable isotope studies using d5-phenyalanine infusion studies published previously.,,, Graphs are averages ± SEM. White bars represent patients with burns <40% total body surface area (TBSA). Striped bars represent patients with burns ≥40% TBSA. Values from nonburned, normal patients are represented by dashed lines (—).
Figure 3
Figure 3
Effects of metabolic dysfunction postburn.
Figure 4
Figure 4
Effect of sepsis on resting energy expenditure, muscle protein breakdown, and fractional synthetic rate of muscle protein synthesis compared with like-sized burns. Changes in net protein balance of muscle protein synthesis and breakdown induced by burn injury was measured by stable isotope studies using d5-phenyalanine infusion studies published previously.,,, Graphs are averages ± SEM. White bars represent nonseptic patients with burns ≥40% total body surface area (TBSA). Striped bars represent septic patients with burns ≥40% TBSA. Values from nonburned, normal patients are represented by dashed lines (—).
Figure 5
Figure 5
Nonpharmacologic modulations of the hypermetabolic response postburn. Demonstrates effect of early excision and grafting, environmental thermoregulation, high-carbohydrate diet and exercise on physiologic derangements postburn.,,,, Graphs are averages ± SEM. White bars represent patients with burns ≥40% total body surface area (TBSA) that had early excision. Striped bars represent patients with burns ≥40% TBSA that had late excision of burn eschar. Averages for burn patients are represented by solid curves. Values from non-burned, normal patients are represented by dashed lines (—).
Figure 6
Figure 6
Insulin. Effect of insulin therapy on the fractional synthetic rate of muscle protein synthesis, lean body mass, and average blood glucose levels., Changes in net protein balance of muscle protein synthesis and breakdown induced by burn injury was measured by stable isotope studies using d5-phenyalanine infusion studies published previously.,, Graphs are averages ± SEM. White bars represent patients with burns ≥40% total body surface area (TBSA) that received no anabolic agents or insulin. Striped bars represent patients with burns ≥40% TBSA who were randomized to receive insulin.
Figure 7
Figure 7
Oxandrolone. Effect of oxandrolone treatment on the fractional synthetic rate of muscle protein synthesis, lean body mass, and strength., Changes in net protein balance of muscle protein synthesis and breakdown induced by burn injury was measured by stable isotope studies using d5-phenyalanine infusion studies published previously.,, Graphs are averages ± SEM. White bars represent patients with burns ≥40% total body surface area (TBSA) who received no anabolic agents. Striped bars represent patients with burns ≥40% TBSA that were randomized to receive oxandrolone.
Figure 8
Figure 8
Propranolol. Effect of propranolol treatment on the fractional synthetic rate of muscle protein synthesis, lean body mass, and cardiac work. Changes in net protein balance of muscle protein synthesis and breakdown induced by burn injury was measured by stable isotope studies using d5-phenyalanine infusion studies published previously.,, Graphs are averages ± SEM. White bars represent patients with burns ≥40% total body surface area (TBSA) that received no anabolic agents. Striped bars represent patients with burns ≥40% TBSA that were randomized to receive propranolol. Values from nonburned, normal patients are represented by dashed lines (—).
Figure 9
Figure 9
Relative efficacy of the different anabolic agents to improve muscle protein synthesis compared with standard of care alone. Changes in net protein balance of muscle protein synthesis and breakdown induced by burn injury was measured by stable isotope studies using d5-phenyalanine infusion studies published previously.,,,,,, *p < 0.05. Graphs are averages ± SEM. White bars represent patients with burns ≥40% total body surface area (TBSA) that received no anabolic agents. Black bars represent patients with burns ≥40% TBSA that were randomized to receive drug.
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