Volume 21, Issue 5 p. 430-437
Invited Review

Energy Expenditure and Protein Requirements After Traumatic Injury

David Frankenfield MS, RD, CNSD

Corresponding Author

David Frankenfield MS, RD, CNSD

Department of Clinical Nutrition, Penn State's Milton S. Hershey Medical Center, Hershey, Pennsylvania

Correspondence: David Frankenfield, MS, RD, CNSD, Chief Clinical Dietitian, Department of Clinical Nutrition, Penn State's Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033. Electronic mail may be sent to [email protected].Search for more papers by this author
First published: 01 October 2006
Citations: 52

Abstract

Traumatic injury induces hypermetabolism. The degree of hypermetabolism can be variable, depending on the type of injury, the degree of inflammation, body composition, age, and treatment regimens. To estimate metabolic rate in some types of injury, predictive equations have been published. Some of these equations have been tested in validation studies. For other types of injury, equations do not exist. Some expert panels have recommended measuring in lieu of estimating metabolic rate, though studies have not been performed to determine whether clinical outcome is affected by the method used to determine energy requirements. Traumatically injured patients are usually catabolic, but protein needs after traumatic injury continue to be debated. Some suggest that 1.5 g protein per kg body weight is adequate and that any additional protein is simply oxidized, adding to the nitrogen load to be excreted. Alternately, protein intake >2.0 g/kg body weight increases the absolute rate of body protein synthesis, and achievement of nitrogen balance has been associated with survival. Thus, provision of high-protein feeding to achieve nitrogen balance might be worthwhile, even if that balance is achieved at the cost of additional nitrogen production.