[Energy demands and supply in polytraumatized patients in the postoperative phase]

Abstract

Normal enteral feeding cannot be maintained after trauma. Post-aggression metabolism or socalled "flow phase" usually results from hormonal changes, including rise in catecholamine and cortisole, drop in testosterone as well as T3 and T4, and relative hGH deficit. Glucose intolerance, increased demand for energy, and catabolism are the consequences along with reduced protein uptake and increased protein breakdown with all associated complications. Indirect calorimetry is an important method to determine energy requirements and, above all, is used to monitor nutrition and other therapeutic interventions. Substrate requirement and distribution of substrate supplies are discussed in some detail. All-in-one solutions and tube feeding have quite often proved helpful in providing patients with sufficient and properly adapted nutrition. On top of adequate nutrition, catabolism is therapeutically controlled by medication, using beta-blockers and hGH. The need for supervision of nutrition is also discussed.