High Protein Enteral Feedings: A Means of Achieving Positive Nitrogen Balance in Head Injured Patients

Abstract

In an attempt to improve early enteral nitrogen replacement, nitrogen status was compared in two groups of head injured patients receiving enteral regimens of 38 to 51 kcal/kg/day with different protein concentrations. Eleven control patients received 1.5 g protein/kg/day and 10 study patients received 2.2 g protein/kg/day. Daily nitrogen excretion, corrected nitrogen balance, blood urea nitrogen changes, and enteral formula tolerance were compared between groups over a 10-day period. Those receiving 2.2 g protein/kg/day had significantly higher daily and cumulative nitrogen balances despite their higher nitrogen excretion levels. Over 10 days, the study group retained 9.2 g nitrogen. By comparison, the control group sustained a cumulative loss of 31.2 g nitrogen over 10 days, despite a mean intake of 109 g protein/day. In both groups, full strength, full rate feedings were not possible until day 10 postinjury. These data indicate that once enteral formulas are tolerated high nitrogen regimens are required to achieve positive nitrogen balance in acute severe head injury patients.

Elevated intracranial pressure associated with hypermetabolism in isolated head trauma

“…More data points are needed in the recovery stage to determine the overall effect of negative nitrogen balance. Previous reports indicate that negative nitrogen balance is not necessarily a detriment to the patient's overall outcome 4' 12, and that it is extremely difficult to achieve a positive nitrogen balance in this group of patients 5, 16,17,19 In summary, our study suggests that elevated ICP is associated with increased oxygen consumption, caloric expenditure, protein catabolism and overall hypermetabolism in severely head injured patient.…”

Metabolic assessment and enteral tube feeding usage in children with acute neurological diseases

“…26 In children with head trauma or with severe CNS infection, a nitrogen to non-protein calorie ratio of 1:150 to 1:100 is recommended. 27 Patients with acute CNS disease are frequently comatose or have impairment of swallowing reflexes, generally receiving parenteral or enteral tube feeding. Enteral nutrition presents several obvious advantages over parenteral nutrition, since it is more physiological, its costs are lower and it presents a lower incidence of complications.…”

Protein in der klinischen Ernährung kritisch kranker Patienten

“…[12 -29]. Davon wurden 7 Studien an allgemein kritisch kranken Intensivpatienten durchgeführt [22, 23, 25 -29], 4 an Verbrennungspatienten [12,15,21,24], 2 an neurochirurgischen Patienten [17,18], 4 weitere an Patienten, die aus diversen Gründen einer parenteralen oder enteralen Ernährung bedurften [13,14,16,20]…”