Metabolic response to severe surgical illness: Overview

Severe surgical illness results in metabolic responses that mobilize substr ate (amino acids and fatty acids) from body stores to support vital organs, enhance resistance to infection, and ensure wound healing. Central to this process is the redistribution of body protein, which moves From skeletal m uscle to support the central viscera. If unsupported, this protein-wasting state could result in prolonged convalescence, diminished immunity, and poo r wound healing. Present evidence suggests that the central nervous system plays a major role in regulating this protein catabolic response. Infusing exceedingly small quantities of the proinflammatory cytokines into the brai n can mimic injury responses, and central cytokine blockade may be one ther apeutic approach to attenuating these responses safely in the future. Addit ional evidence also demonstrates that the function of the hypothalamus and anterior pituitary is dampened during the later stages of severe surgical i llness, and the possibility of hormonal replacement therapy needs to he exp lored.