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Nutrient support of the healing wound
N A Meyer1, M J Muller, D N Herndon
1Shriners Burns Institute, Galveston, TX 77550-2725.
New Horizons (Baltimore, Md.)
|May 1, 1994
Summary
Critically ill patients experience impaired wound healing due to stress responses. Nutritional support, including protein, arginine, and vitamins A, B, and C, optimizes healing in these patients.
Area of Science:
- Biochemistry
- Physiology
- Nutrition Science
Background:
- Wound healing involves complex physicochemical interactions requiring micronutrients.
- Critically ill patients exhibit impaired wound healing due to a stress-induced protein-catabolic, hypermetabolic state.
- Stress hormones (catecholamines, cortisol, glucagon) augment thermogenesis, lipolysis, and proteolysis, leading to skeletal muscle degradation.
Purpose of the Study:
- To investigate the role of nutritional support in optimizing wound healing in critically ill patients.
- To explore the impact of anabolic agents on reversing protein catabolism and improving wound healing.
- To determine the efficacy of specific nutrient supplementation (protein, arginine, vitamins A, B, C) in supporting wound repair.
Main Methods:
- Analysis of the physiological stress response, including hypothalamic and hormonal pathways.
- Evaluation of protein catabolism and amino acid transport defects in hypermetabolic states.
- Assessment of the effects of growth hormone and insulin-like growth factor-1 on wound healing.
- Investigation of nutrient supplementation strategies, including protein, arginine, and vitamin combinations.
Main Results:
- Stress hormones induce thermogenic futile substrate cycling, lipolysis, and proteolysis, increasing glucose production at the expense of skeletal muscle.
- Increased amino acid availability alone does not reverse protein catabolism due to impaired amino acid transport.
- Anabolic agents like growth hormone and insulin-like growth factor-1 can reverse amino acid transport defects.
- Growth hormone treatment significantly improves wound healing in severely burned children.
- Supplementation with protein, arginine, and vitamins A, B, and C optimizes nutrient support for wound healing.
Conclusions:
- Nutritional support is crucial for efficient wound healing in hypermetabolic patients.
- Anabolic agents are necessary to overcome protein catabolism and improve wound healing.
- Specific nutrient supplementation, including protein, arginine, and vitamins A, B, and C, provides optimal support for wound healing.