Initiators and propagators of the metabolic response to injury

Injury produces tissue hypoperfusion and subsequent reperfusion, afferent n eural activity, and immune and vascular endothelial activation. These, in t urn, set up a cascade of events coordinated by the central nervous system a nd at the level of individual tissues such as the liver, gut, and skeletal muscle. They are mediated by a complex array of neutrophil and macrophage p roducts, The changes result in hypermetabolism, lypolysis, lysis of skeleta l muscle and visceral protein, and expanded extracellular fluid with conseq uent organ failure.