title: Preinjury Fed State Alters the Physiologic Response in a Porcine Model of Hemorrhagic Shock and Polytrauma.
abstract: BACKGROUND
  Hemorrhagic shock and injury lead to dramatic changes in metabolic demands and continue to be a leading cause of death. We hypothesized that altering the preinjury metabolic state with a carbohydrate load prior to injury would affect subsequent metabolic responses to injury and lead to improved survival.
  
  
  METHODS
  Sixty-four pigs were randomized to fasted (F) or carbohydrate prefeeding (CPF) groups and fasted 12 h prior to experiment. The CPF pigs received an oral carbohydrate load 1 h prior to anesthesia. All pigs underwent a standardized injury/hemorrhagic shock protocol. Physiologic parameters and laboratory values were obtained at set time points.
  
  
  RESULTS
  Carbohydrate prefeeding did not convey a survival benefit; instead, CPF animals had greater mortality rates (47% vs. 28%; P = 0.153; log-rank [Mantel-Cox]). Carbohydrate prefeeding animals also had higher rates of acute lung injury (odds ratio, 4.23; 95% confidence interval, 1.1-16.3) and altered oxygen utilization. Prior to shock and throughout resuscitation, CPF animals had significantly higher serum glucose levels than did the F animals.
  
  
  CONCLUSIONS
  Carbohydrate prefeeding did not provide a survival benefit to swine subjected to hemorrhagic shock and polytrauma. Carbohydrate prefeeding led to significantly different metabolic profile than in fasted animals, and prefeeding led to a greater incidence of lung injury, increased multiorgan dysfunction, and altered oxygen utilization.
authors.affiliation: Division of Critical Care and Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Kristin P
authors.initials: KP
authors.lastname: Colling
authors.forename: Uroghupatei P
authors.initials: UP
authors.lastname: Iyegha
authors.forename: Javariah I
authors.initials: JI
authors.lastname: Asghar
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Lexcen
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Lusczek
authors.forename: Charles E
authors.initials: CE
authors.lastname: Determan
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Witowski
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Mulier
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Beilman
mesh_terms: D055371:Acute Lung Injury / Q000473:pathology; D000818:Animals; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004195:Disease Models, Animal; D005215:Fasting; D005947:Glucose / Q000737:chemistry; D008297:Male; D009104:Multiple Trauma / Q000378:metabolism*; D016017:Odds Ratio; D010100:Oxygen / Q000378:metabolism; D016016:Proportional Hazards Models; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000473:pathology*; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004040:Dietary Carbohydrates; D005947:Glucose; D010100:Oxygen