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12. Lusczek ER, Vincent T, Lexcen D, et al. Metabolic networks
Efficacious early care following combat trauma has tradi- in a porcine model of trauma and hemorrhagic shock dem-
tionally focused on earlier and speedier care after injury. onstrate different control mechanism with carbohydrate pre-
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morbidity and mortality, control symptoms, and mitigate ting: body mass index independently contributes to hyperco-
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the secondary effects of trauma through the judicious 30–36; discussion 7–8.
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jury has occurred. This proposal has major challenges to beta-methylbutyrate supplementation in critically ill trauma
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the establishment of a robust evidence base, ethical dis- 15. Portal S, Zadik Z, Rabinowitz J, et al. The effect of HMB
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17. Committee on Military Nutrition Research, Food and Nu-
This work is the opinion of the authors and does not trition Board, Institute of Medicine. Military strategies for
represent official policy or research strategy of the UK sustainment of nutrition and immune function in the field.
Defence Medical Services. The ideas discussed herein are Washington, DC: National Academies Press.
speculative and it is our intention to stimulate discus- 18. Resnick S, Inaba K, Okoye O, et al. Impact of smoking on
sion and to expand the conceptual framework within trauma patients. Ulusal Travma Ve Acil Cerrahi Derg. 2014;
20:248–252.
which trauma care is considered rather than provide 19. Zhao Z, Sabirzhanov B, Wu J, et al. Voluntary exercise pre-
fully evidence-based and tested clinical options. conditioning activates multiple antiapoptotic mechanisms
and improves neurological recovery after experimental trau-
matic brain injury. J Neurotrauma. 2015;32:1347–1360.
Disclosures 20. Chang CK, Chou W, Lin HJ, et al. Exercise preconditioning
The authors have nothing to disclose. protects against spinal cord injury in rats by upregulating
neuronal and astroglial heat shock protein 72. Int J Mol Sci.
2014;15:19018–19036.
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