RESUMO
Burn injury represents a significant problem worldwide. Advances in therapy strategies, based on better understanding of the pathophysiologic responses after burn injury have improved the clinical outcome of patients with burn injuries over the past years. This article describes the present understanding of the pathophysiology of a burn injury including both the local and systemic responses, focusing on the many facets of organ and systemic effects directly resulting from hypovolemia and circulating mediators following burn trauma.
Assuntos
Queimaduras/fisiopatologia , Angiotensina II/fisiologia , Animais , Queimaduras/etiologia , Queimaduras/terapia , Catecolaminas/fisiologia , Edema/fisiopatologia , Hemodinâmica/fisiologia , Histamina/fisiologia , Humanos , Hipovolemia/fisiopatologia , Mediadores da Inflamação/sangue , Fator de Ativação de Plaquetas/fisiologia , Prostaglandinas/fisiologia , Serotonina/fisiologia , Pele/fisiopatologia , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/fisiopatologia , Lesões dos Tecidos Moles/terapia , Tromboxanos/fisiologia , Resistência Vascular/fisiologia , Vasopressinas/fisiologiaRESUMO
At the 2007 International Symposium on Intensive Care and Emergency Medicine (ISICEM) in Brussels, a roundtable conference on "Metabolic Support in Sepsis and Multiple Organ Failure" was held. The roundtable was endorsed by the European Society of Intensive Care Medicine, the Society of Critical Care Medicine, the European Society for Clinical Nutrition and Metabolism, and the American Society for Parenteral and Enteral Nutrition. Metabolic support in intensive care has become an exciting topic in recent years, with improved understanding of the effects of compromised mitochondrial function, studies demonstrating outcome benefits of tight glucose control, new insights into the mechanisms behind insulin resistance, recognition of glutamine and antioxidants as key nutrients, and emerging knowledge concerning the interactions between metabolism and endocrinology. Together, these aspects have generated an increased interest in the importance of metabolism in intensive care medicine, reflected in the programs and abstracts at international congresses of the past few years. This roundtable's participants each gave a presentation within their specific area of expertise, and each was followed by general discussion. Discussions became heated as new concepts and ideas were debated. New data will be discussed in this summary which reveals metabolic and nutrition interventions that could lead to major improvements in clinically relevant outcomes.