[Response to aggression: evaluation and therapeutic implications. Work Group on Metabolism and Nutrition of the...

The metabolic response to stress/aggression is a complex process which is mainly mediated by the interaction between the neuro-endocrine system and the circulating cytokines. This interaction brings about physiological and metabolic alterations--severe metabolic-nutritional deficits--of the hypermetabolic type, muscular proteolysis, lipolysis, glycogenolysis, and gluconeogenesis among others, which should be studied and understood prior to initiating or not a nutritional support. The parenteral or enteral nutritional support is usually indicated to prevent a worsening of these situations of altered metabolism frequently associated with inanition, although one should not attempt to revert to normal preexisting deficit situations. On the other hand, and is this special context, we should not forget the advances in nutrients with pharmacological effects, and in pharmacological nutrition. At this II Consensus Conference of the SEMIUC (Sociedad Española de Medicine Intensiva y Unidades Coronarias = Spanish Society of Intensive Medicine and Coronary Units), we have proposed four objectives: i) To make recommendation, based both on the scientific evidence, as on the experience of the components. ii) Define the scientific terminology to be used in this specific context. iii) Give an answer to the different and assorted clinical problems which are secondary to a situation of stress which has a multiple etiology. iv) Provide new ideas for the development of clinical trails and studies of this specific context.