Nutrition and pharmacologic support to address metabolic demands following trauma: a narrative review

Severe traumatic injury triggers a profound hypermetabolic and hypercatabolic response, marked by increased resting energy expenditure, accelerated protein breakdown, muscle wasting, and heightened risk of malnutrition, infection, and mortality. Timely and targeted nutritional intervention is therefore essential to support immune function, promote wound healing, and facilitate recovery. Herein, we examine the metabolic demands of patients with severe trauma and synthesize current clinical guidelines and evidence-based strategies for nutritional management. This review outlines the neuroendocrine, inflammatory, and metabolic mechanisms that drive hypercatabolism following major trauma. It evaluates methods for estimating energy expenditure and their limitations, and discusses recommended caloric and protein targets, as well as timing of initiation and preferred routes of nutritional support. Additionally, our review examines the evidence for adjunctive immunonutrition, including supplementation of glutamine, omega-3 fatty acids, arginine, and ghrelin. In summary, early and individualized nutritional therapy is critical to mitigating hypercatabolism and improving clinical outcomes in trauma patients. Although foundational guidelines have been established, high-quality randomized controlled trials remain necessary to better define the role of specific immunonutrients across diverse trauma populations.