Nutrition Considerations in Traumatic Brain Injury

Abstract

The provision of adequate nutrition support for patients with traumatic brain injury (TBI) has been a clinical challenge for decades. The primary and secondary injuries create unique metabolic derangements along with accompanying issues such as optimal timing and route of nutrition, appropriate fluid and electrolytes, drug administration, rehabilitation, and dysphagia. Enteral nutrition is clearly established as the preferential route of nutrition support for this population vs parenteral nutrition. There appears to be a consensus on early initiation of enteral nutrition, but less definitive are recommendations on advancement timing and formula components. Nutrition therapies should include exact fluid resuscitation goals specific for TBI and strict electrolyte monitoring to avoid extreme fluid, electrolyte, or glucose shifts that could be detrimental to the patient. While the critical care patient often tolerates small bowel feeding, the long-term rehabilitation patient should transition to and tolerate gastric feeding. Drug-nutrient and adverse drug reactions such as diarrhea should be routinely evaluated in patients receiving enteral nutrition. Monitoring for dysphagia is critical to avoid the costly negative aspects associated with aspiration and to capitalize on quality of life and appropriate oral nutrition. Emphasizing the priority of early nutrition support within a multi-disciplinary team may be the critical key for successful provision and tolerance of nutrition support in the TBI population.

The Hormone Ghrelin Prevents Traumatic Brain Injury Induced Intestinal Dysfunction

“…Patients manifesting post-TBI GI dysfunction have increased morbidity and longer periods of hospitalization; therefore, treatment modalities targeting prevention of GI dysfunction have important clinical implications (Cook et al, 2008;Kemp et al, 2008). Previously, we, along with others, have shown, in a mouse model, that TBI causes GI dysfunction characterized by increased intestinal permeability and marked mucosal injury, which was confirmed by intestinal histology Feighery et al, 2008;Hang et al, 2003).…”

Aetiology and treatment outcome of severe traumatic brain injuries in neurosurgical center with inadequate facilities

“…RTA formed 73.14% of the etiologies. Lyle et al 17 in their study of clinical course and outcome of 159 severe head injury patients in Australia found that majority were males with a ratio of 2.7:1 to females. Their mean age was 30 years and 74% were under 40 years with RTA constituting 65% of the etiological factors.…”

Traumatic Brain Injury - Acute Care

“…Monitoring of cerebral perfusion and oxygenation, which is discussed in subsequent sections, is particularly crucial in this scenario (Young et al 2010). Because of the brain's role in regulating metabolism, patients with severe traumatic brain injury demonstrate a number of metabolic derangements which ultimately result in systemic catabolism (Cook, Peppard, & Magnuson 2008). Adequate nutritional support is essential to forestall adverse consequences, including protein loss and immunocompromise (Sacks et al 1995).…”

“…Patients with severe TBI will require replacement of approximately 140% of their resting energy expenditure, though this requirement will be decreased somewhat in the setting of pharmacological paralysis or deep sedation. Protein requirements are estimated at about 1.5-2 grams/kg of protein (Cook, Peppard, & Magnuson 2008). Close monitoring is essential to ensure adequate supplementation and avoid complications such as hyperglycemia.…”