Interpretation of the metabolic effects of trauma and sepsis.

John Hunter suggested that the body's responses to injury were defensive and had survival value. Now, many years later, we are still uncertain about this. Although our appreciation of the endocrine and metabolic responses to injury, both physical and bacterial, has increased enormously our knowledge of these events, particularly at a molecular level, is still very incomplete. Patterns have been identified, however, in the sphere of energy metabolism, and this provides a basis for interpreting at least some of the biochemical responses to injury. The views developed support the idea that the responses are defensive--initially against the impact of the injury and then to meet the demands of the new "organ" which the wounds or septic focus seem to have added to the body. A reason for wanting to interpret these responses is to improve patient care. Current interpretations at least help to clarify our view of what is happening in the injured or septic patient and sometimes indicate lines of treatment. Nevertheless, many serious problems, particularly changes in protein metabolism, remain to be solved before we can advise on the metabolic care of patients at all stages from accident to recovery.