Nutritional support for head-injured patients

Perel, Pablo; Yanagawa, Toshihiko; Bunn, Frances; Roberts, Ian; Wentz, Reinhard

doi:10.1002/14651858.cd001530.pub2

Cited by 98 publications

(62 citation statements)

References 24 publications

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“…A review by the Cochrane Collaboration concluded that early nutritional support may be associated with a trend towards better outcomes in terms of survival and disability in this patient group. 1 More recent work demonstrated that patients who were not fed within 5 and 7 days after TBI had a two-and four-fold increased likelihood of death. 2 However, the provision of adequate nutritional support to meet individual energy demands is often challenging in practice.…”

Section: Introductionmentioning

confidence: 99%

Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: Comparison of prediction equations with indirect calorimetry values

2009

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Section: Introductionmentioning

confidence: 99%

Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: Comparison of prediction equations with indirect calorimetry values

2009

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“…Data is similarly lacking for the use of PEG in dysphagic patients with Parkinson's disease (Deane et al, 2001). A recent meta-analysis of nutritional support in head-injured patients concluded that, while data are lacking, early feeding may be associated with a trend toward better outcomes in terms of survival and disability (Perel et al, 2006). Amyotrophic Lateral Sclerosis (ALS) is another condition where PEG is routinely employed (James et al, 1998;James et al, 2005;Rimon et al, 2005;Mitsumoto et al, 2003).…”

Section: Indications For Percutaneous Endoscopic Gastrostomymentioning

confidence: 99%

Percutaneous Endoscopic Gastrostomy in Neurological Patients

Burke¹,

Geller²

2011

Gastrostomy

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“…With respect to early enteral feeding, clinicians' use is supported by a recent systematic review that revealed a relative risk for death with early enteral feeding of 0.67 (95% CI 0.41-1.07). 17 However, intensive glucose control was much more appropriate than its estimated frequency of use. Given that the original study demonstrating the benefit of tight glucose control among the critically ill included very few neurologically-impaired patients, 18 clinicians may be indicating some reservation about applying this evidence in their practice.…”

Section: The Canadian Journal Of Neurological Sciences 310mentioning

confidence: 99%

Survey of Management of Severe Head Injury in Canada

Jacka

Zygun²

2007

Can. j. neurol. sci.

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Severe closed head injury (CHI) is a significant clinical and public health problem, with the Canadian incidence estimated at 11.4 per 100000. 1 The frequency of use, perceived appropriateness, and effectiveness of preventive and therapeutic interventions for severe CHI remain unknown. 2,3 Although guidelines for the treatment of severe CHI exist, 4 some investigations have suggested that more aggressive treatment is ABSTRACT: Objective: To determine: 1. the degrees of consensus and disagreement among Canadian critical care clinicians regarding the appropriateness (benefit exceeding risk) of common therapeutic manoeuvres in patients with severe closed head injury (CHI), and 2. the frequency with which clinicians employed these manoeuvres. Methods: The study design was a systematic scenario-based survey of all neurosurgeons and critical care physicians treating patients with severe CHI in Canada. Results: In the scenario of acute epidural hematoma with mass effect, respondents agreed very strongly that surgery was appropriate. Clinicians reported mannitol and hypertonic saline as appropriate. Beyond these two interventions, agreement was less strong, and the use of the extraventricular drain (EVD), phenytoin, cooling, hyperventilation, nimodipine, and jugular venous oximetry (JVO) were of uncertain appropriateness. Steroids were considered inappropriate. In a scenario of diffuse axonal injury (DAI), clinicians agreed strongly that fever reduction, early enteral feeding, intensive glucose control, and cerebral perfusion pressure (CPP)-directed management were appropriate. The use of mannitol, hypertonic saline, EVD, JVO, narcotics and propofol were also appropriate. Neuromuscular blockade, surgery, and hyperventilation were of uncertain appropriateness. The appropriateness ratings of the interventions considered in the scenario of an intracranial contusion mirrored the DAI scenario. In general, correlations between the reported appropriateness and frequency of use of each intervention were very high. An exception noted was the use of the JVO. The correlation between CPP-guided therapy and the use of the EVD was weak. Conclusions: This survey has described current practice with regard to treatment of patients with severe CHI. Areas of variation in perceived appropriateness were identified that may benefit from further evaluation. Suggested priorities for evaluation include the use of osmotic diuretics, anticonvulsants, and intracranial manometry.RÉSUMÉ: Enquête sur le traitement du traumatisme cérébral sévère au Canada. Objectif : Nous voulions déterminer le degré de consensus ou de désaccord entre les médecins réanimateurs concernant la pertinence (bénéfices/risques) de traitements couramment utilisés dans la prise en charge des traumatismes crâniens fermés sévères (TCF) et la fréquence d'utilisation de ces traitements. Méthodes : Nous avons effectué une enquête systématique basée sur des scénarios auprès de tous les neurochirurgiens et médecins réanimateurs qui traitent des patients atteints de TCF au Canada. Rés...

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Nutritional support for head-injured patients

Abstract: This review suggests that early feeding may be associated with a trend towards better outcomes in terms of survival and disability. Further trials are required. These trials should report not only nutritional outcomes but also the effect on death and disability.

Cited by 98 publications

References 24 publications

Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: Comparison of prediction equations with indirect calorimetry values

Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: Comparison of prediction equations with indirect calorimetry values

Percutaneous Endoscopic Gastrostomy in Neurological Patients

Survey of Management of Severe Head Injury in Canada

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