Metabolism and nutrition in patients with moderate and severe traumatic brain injury: A systematic review

Krakau, Karolina; Omne-Pontén, Marianne; Karlsson, Torbjörn; Borg, Jörgen

doi:10.1080/02699050500487571

Cited by 69 publications

(54 citation statements)

References 52 publications

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“…We are aware of only one previous systematic review of hypermetabolism following TBI that incorporated the results from 14 trials, published from 1993 through 2003 (Krakau et al, 2006). These authors reported similar, although less variable results compared with the present study, with deviations in MEE=PEE of 96-160%.…”

Section: Discussionsupporting

confidence: 72%

Hypermetabolism following Moderate to Severe Traumatic Acute Brain Injury: A Systematic Review

Foley

Marshall

Pikul

et al. 2008

Journal of Neurotrauma

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Elevations of metabolic rate following traumatic brain injury (TBI) have been reported previously, with estimates ranging from 32% to 200% above normal values. The aim of this systematic review was to describe the pattern of energy expenditure during the first 30 days following TBI. We searched six databases for trials that measured the energy expenditure at least once during the first 30 days post-injury and compared that value to one that would be predicted in the non-injured state. We identified 24 studies, three of which were randomized controlled trials (RCTs). The sample sizes of the included studies ranged from 6 to 80 (mean, 24.7), and the mean Glasgow Coma Scale (GCS) score of subjects was 4.8. Mean energy expenditure, expressed as a percentage of a predicted value, ranged from 75% to 200%. The lowest values were reported in patients admitted in brain death. Several factors were found to have modulating effects on energy expenditure. The administration of paralyzing agents, sedatives, or barbiturates reduced metabolic rate by approximately 12-32%. Propranolol and morphine were associated with smaller decreases in energy expenditure. Factors that do not appear to augment the hypermetabolic response included the administration of steroids and method of feeding (enteral vs. parenteral). Based on our results, it was unclear if elevated temperature, the presence of extracranial injury, or the severity of injury further exacerbate hypermetabolism. We conclude that energy expenditure following TBI is highly variable, and the use of standard factors to estimate the energy needs of individual patients are inappropriate and should be discouraged.

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Section: Discussionsupporting

confidence: 72%

Hypermetabolism following Moderate to Severe Traumatic Acute Brain Injury: A Systematic Review

Foley

Marshall

Pikul

et al. 2008

Journal of Neurotrauma

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show abstract

“…Metabolism rates range between 96 % and 160 % of the predicted values (Krakau et al 2006). In patients with barbiturate coma therapy or in those receiving neuromuscular blocking drugs, energy consumption could be reduced from 160 % to 120 %, which is still an elevated value.…”

Section: How Many Calories Should Be Administered?mentioning

confidence: 98%

RETRACTED CHAPTER: Brain Trauma and Nutritional Support

Wetsch¹,

Böttiger²,

Padosch³

2015

Diet and Nutrition in Critical Care

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“…Such complications include well-known conditions such as swallowing dysfunction, autonomic dysfunction, 57 posttraumatic epilepsy, hydrocephalus, or abnormal muscle activity where the arsenal of specific interventions is growing but where there is much need of systematic evaluation. This is even more so for other systemic complications such as dysautonomy, disturbed energy, 58 and hormone balance, 59 all of which may potentially influence the recovery process. These somatic complications might be considered as ''secondary insults'' with a possible impact on long-term outcome in analogy, with secondary insults identified during neurointensive care.…”

Section: Further Potential and Challenges Related To The Early Rehabimentioning

confidence: 98%

Trends and Challenges in the Early Rehabilitation of Patients with Traumatic Brain Injury

Borg

Røe

Nordenbo

et al. 2011

American Journal of Physical Medicine &Amp; Rehabilitation

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Borg J, Rö e C, Nordenbo A, Andelic N, de Boussard C, af Geijerstam J-L: Trends and challenges in the early rehabilitation of patients with traumatic brain injury: A Scandinavian perspective. Am J Phys Med Rehabil 2011;90:65Y73.Traumati c brain injury (TBI) is a recognized public health problem worldwide 1Y3 and offers one of the most challenging areas in modern rehabilitation medicine. Primary prevention programs have included safety measures in transportation systems, campaigns related to alcohol and drug issues, and legislation on use of safety belts and helmets. 4 These programs have had a documented impact on the incidence and severity of TBI in many countries, including the Scandinavian. 5 Secondary prevention related to improved emergency and transportation systems, as well as modern neurointensive care and neurosurgery, has reduced mortality and morbidity after TBI, 6 although further decline of mortality rates during the past two decades is less clear. 7 Thus, even if the impact of primary and secondary prevention is obvious and generally acknowledged, a ''null vision'' for TBI will remain a vision during foreseeable time as will treatment that is curative. Furthermore, there is consistent evidence that factors other than injury severity, such as depression, anxiety, and low selfesteem, 8 are main determinants of meaningful long-term outcome after TBI. Thus, there will be a continuous need for access to evidence-based rehabilitation programs for patients who have suffered a TBI. One obvious trend in many Western countries including the Scandinavian 9Y11 is that the incidence of TBI in the elderly is increasing and thus offering a particular challenge for the rehabilitation systems. Even if the prerequisites may differ significantly between countries and regions, some basic principles with regard to optimal rehabilitation organization and rehabilitation processes after TBI should probably be the same.The Scandinavian countries are fairly homogeneous with regard to sociodemography, healthcare systems, laws, and attitudes. There is a long tradition for organization and resource allocation within the Scandinavian healthcare systems for comprehensive rehabilitation, as reflected by spinal cord injury units introduced already in the 1950s and stroke units introduced in the 1990s. 12Y14

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Metabolism and nutrition in patients with moderate and severe traumatic brain injury: A systematic review

Abstract: The impact of timing, content and ways of administration of nutritional support on neurological outcome after TBI remains to be demonstrated.

Cited by 69 publications

References 52 publications

Hypermetabolism following Moderate to Severe Traumatic Acute Brain Injury: A Systematic Review

Hypermetabolism following Moderate to Severe Traumatic Acute Brain Injury: A Systematic Review

RETRACTED CHAPTER: Brain Trauma and Nutritional Support

Trends and Challenges in the Early Rehabilitation of Patients with Traumatic Brain Injury

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