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Physiology and metabolism in closed head injury

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Abstract

Studies on metabolism in head injury have indicated the presence of some degree of elevation in metabolic rate associated with extensive nitrogen wasting. Cardiodynamics are consistent with an adaptive increase in substrate delivery in an effort to meet the increased tissue demands. Most studies suffer from lack of longitudinal data and an inability to separate the effects of the injury from the effects imposed by some frequently utilized treatment modalities. In this article, the existing literature on metabolism and cardiodynamics is reviewed and contrasted with the findings of a study intended to focus on changes over time as well as to eliminate as many of the contaminating modalities as possible.

Résumé

Les études du métabolisme chez les sujets victimes d'un traumatisme céphalique ont montré un certain degré d'élévation du taux du métabolisme associée à une déperdition azotée considérable. La dynamique cardiaque se conforme à une augmentation du débit du substrat qui est nécessaire pour répondre à la demande accrue des tissus. De nombreuses études manquent de données évolutives et ne permettent pas de distinguer les effets propres du traumatisme céphalique de ceux inhérents à certains agents médicamenteux. Dans cet article, la littérature existante consacrée au métabolisme et à la dynamique cardiaque est passée en revue et opposée aux données d'une étude centrée sur les modifications en fonction du temps et aussi sur l'élimination des facteurs interférents.

Resumen

Estudios metabólicos en pacientes con trauma de cabeza indican un cierto grado de elevación de la tasa metabólica asociado con gran pérdida de nitrógeno. Los cambios cardiodinámicos son consistentes con un incremento adaptante en la provisión de substratos en un esfuerzo por atender a la aumentada demanda tisular. La mayoría de los estudios carecen de information longitudinal y no permiten separar los efectos de la lesión de los efectos impuestos por algunas de las modalidades terapéuticas. Ciertos fundamentos de manejo del trauma cráneocerebral pueden alterar el metabolismo y la fisiología. Ejemplos son la deshidratación o el uso de esteroides, relajantes musculares, y barbitúricos; muchas observaciones han sido realizadas en pacientes bajo intenso soporte nutricional, el cual tambien puede alterar la respuesta. En este artículo, se revisan la literatura existente sobre metabolismo y cardiodinámica y se contrastan con los hallazgos de un estudio orientado a definir los cambios que ocurren con la evolutión del trauma así como a eliminar las modalidades “contaminantes.”

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  1. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Blalock 14, 21205, Baltimore, Maryland, USA

    Clifford Scott Deutschman M.S., M.D.

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  1. Clifford Scott Deutschman M.S., M.D.
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Deutschman, C.S. Physiology and metabolism in closed head injury. World J. Surg. 11, 182–193 (1987). https://doi.org/10.1007/BF01656401

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