Metabolic Response to Trauma by Nwabueze S.E.pptx

Many of these physiological changes can be
modified or corrected by treatments.
• Although the metabolic response aims to return an
individual to health, it can sometimes have harmful
effects. For example, a major response can damage
organs distant to the injured site itself
•In modern surgery, a major goal is to minimize the
metabolic response to surgery in order to shorten
recovery times.

1. Metabolic Response to Trauma Nwabueze

2. OUTLINE Introduction Initiators of Metabolic response Mediators of metabolic response Response to injury Consequences of metabolic response Attenuating the metabolic response Concept of ERAS Conclusion References

3. INTRODUCTION Definitions Trauma is defined as cellular disruption caused by an exchange with environmental energy that is beyond the body’s resilience. Metabolic response to trauma is a complex set of neuroendocrine mechanisms that act loco-regionally and systemically to try to restore the body to its pre-injury condition following trauma. Metabolic response to trauma is the body’s damage control system intended to maintain homeostasis at cellular as well as systemic level. The metabolic response is GRADED and EVOLVES

4. INTRODUCTION Sources Environment Physical or Mechanical Chemical Biological. The surgeon himself is a potential source of trauma in a major operative intervention.

5. INTRODUCTION Purpose of the response. Restore homeostasis Protects the circulation. Provide energy Prevent or Clear infection Restore tissue function and integrity

6. INTRODUCTION Statement of Surgical Importance Understanding the complex pathways that regulate local and systemic response to trauma is necessary to develop strategic intervention measures after severe injury and where possible before and during as well.

7. INITIATORS OF METBOLIC RESPONSE Many factors initiate the response, however the most important factors include. Damage to vascular integrity. Inflammatory reaction Hypovolaemia Hypoxia/Hypercarbia Pain Emotions and fear

8. INITIATORS OF METBOLIC RESPONSE Graded Nature of the Response The more severe the injury the greater the response. Elective surgery of intermediate severity. Transient and modest rise in T’C, PR , RR, energy expenditure and peripheral WBC cou nt . Following major trauma/sepsis, T hese changes are accentuated, resulting in a systemic inflammatory response syndrome (SIRS), hypermetabolism , marked catabolism, shock and even multiple organ dysfunction (MODS). Evolution of the Response. The metabolic response evolves with time. In particular, the immunological sequelae of major injury evolve. From a pro- inflamatory state ------- compensatory anti- inflamatory response syndrome (CARS) the innate immune system. . suppressed immunity and diminished resistance to infection { macrophages, neutrophils, dendritic cells]. .[ D rive on-going systemic inflammation, the acute phase response and continued catabolism.

9. MEDIATORS OF METBOLIC RESPONSE Detection of Cellular Injury. Endogenous damage-associated molecular patterns (DAMPs) are produced following tissue and cellular injury. These molecules interact with immune and nonimmune cell receptors to initiate a “sterile” systemic inflammatory response following severe traumatic injury. Inflammatory reaction Hypovolaemia Hypoxia/Hypercarbia Pain Emotions and fear