Nutritional support for head-injured patients

Yanagawa, Toshihiko; Bunn, Frances; Roberts, Ian; Wentz, Reinhard; Pierro, Agostino

doi:10.1002/14651858.cd001530

Cited by 28 publications

(19 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results of a systematic review assessing the significance of nutritional support for head-injured patients suggested that early feeding may be associated with a trend toward better outcome in terms of survival and disability, but further studies are needed [39]. …”

Section: Can We Effectively Prevent and Treat Nosocomial Infections Imentioning

confidence: 99%

Untitled

2004

View full text Add to dashboard Cite

Of brain-injured patients admitted to intensive care units, a significant number acquires nosocomial infections. Increased susceptibility to infectious agents could, at least partly, be due to transient immunodepression triggered by brain damage. Immune deficiency in patients with severe brain injury primarily involves T cell dysfunction. However, humoral and phagocytic deficiencies are also detectable. Activation of the hypothalamo–pituitary–adrenal axis and the sympathetic nervous system plays a crucial role in brain-mediated immunodepression. In this review we discuss the role of immunodepression in the development of nosocomial infections and clinical trials on immunomodulation in brain-injured patients with hospital-acquired infections.

show abstract

Section: Can We Effectively Prevent and Treat Nosocomial Infections Imentioning

confidence: 99%

Untitled

2004

View full text Add to dashboard Cite

show abstract

“…[24] As TPN was mostly initiated early in comparison to enteral feeding, better outcome found in TPN[1926] might be just due to the early nutritional replacement and not necessarily dependent on the route of nutritional administration. Only few studies are available to assess the effect of early versus late enteral feeding on the outcome in patients with severe head injury.…”

Section: Discussionmentioning

confidence: 99%

“…[19] Other studies later showed that early nutritional replacement was associated with improved outcome irrespective of enteral or parenteral route. [124] The American Association of Neurological Surgeons’ (AANS) guidelines recommended full nutritional replacement to be instituted by the seventh day. [2] No evidence exists regarding whether early feeding prior to 7 days improves the outcome.…”

Section: Introductionmentioning

confidence: 99%

The prognostic significance of the timing of total enteral feeding in traumatic brain injury

Dhandapani¹,

Dhandapani²,

Agarwal³

et al. 2012

Surg Neurol Int

View full text Add to dashboard Cite

Background:To study the effect of timing of total enteral feeding on various nutritional parameters and neurological outcome in patients with severe traumatic brain injury (TBI).Methods:One hundred and fourteen patients, in the age group of 20–60 years, admitted within 24 h of TBI with Glasgow Coma Scale (GCS) 4–8 were enrolled for the study. Nineteen patients who had expired before the attainment of total enteral feeding were excluded from the analysis. Total enteral feeding was attained before 3 days, 4–7 days, and after 7 days in 12, 52, and 31 patients, respectively, depending on gastric tolerance. They were prospectively assessed for various markers of nutrition and outcome was assessed at 3 and 6 months.Results:Prospective assessment of 67 hospitalized patients at 3 weeks revealed significant differences in anthropometric measurements, total protein, albumin levels, clinical features of malnutrition, and mortality among the three groups. 80% of those fed before 3 days had favorable outcome at 3 months compared to 43% among those fed later. The odds ratio (OR) was 5.29 (95% CI 1.03–27.03) and P value was 0.04. The difference between those fed before 3 days and 4–7 days was not significant at 6 months even though patients fed before 7 days had still significantly higher favorable outcome compared to those fed after 7 days (OR 7.69, P = 0.002). Multivariate analysis for unfavorable outcome showed significance of P = 0.03 for feeding after 3 days and P = 0.01 for feeding after 7 days.Conclusions:In severe TBI, unfavorable outcome was significantly associated with attainment of total enteral feeding after 3 days and more so after 7 days following injury.

show abstract

“…(5,6) Therefore, this article will discuss the most recent evidence on the benefits of nutritional support for craniocerebral trauma patients and make clinical recommendations.…”

Section: Introductionmentioning

confidence: 99%

Terapia nutricional no traumatismo cranioencefálico grave

Campos¹,

Machado

2012

Rev. bras. ter. intensiva

View full text Add to dashboard Cite

Terapia nutricional no traumatismo cranioencefálico grave REVIEW ARTICLE INTRODUCTIONHead trauma (HT) continues to be a highly lethal condition, with an overall mortality of 20% to 50% in the United States of America (USA).(1)HT causes 52,000 deaths annually in the USA, with 85% of these deaths occurring within the first two weeks after the trauma.(2) Brazilian statistics on HT are sparse and are only available for specific regions. In São Paulo, the 1997 HT admission rate was 0.36 per 1,000 inhabitants, with an estimated mortality rate of 26 to 39 per 100,000 inhabitants. Currently, strategies for maintaining brain perfusion and preventing hypoxemia, hypotension and intracranial hypertension have reduced the risk of death and improved severe HT outcomes. (4) In spite of the limited data on the relevance of nutrition therapy for HT patients, two systematic Cochrane Collaboration reviews have suggested ABSTRACTThis article reviews the literature, organizes the major findings, and generates the best evidence-based recommendations on nutrition therapy for head trauma patients. Despite recent advances in head trauma diagnosis and therapy, the mortality associated with this condition remains high. Few therapeutic interventions have been proven to effectively improve this condition. Head trauma causes multiple metabolic and electrolytic disorders; it is characterized by a hypermetabolic state that is associated with intensive catabolism, leading to specific nutritional needs.The current literature lacks specific guidelines for nutrition therapy in severe head trauma patients, although a substantial amount of data has been reported and relevant issues are currently being studied; these data may allow better nutrition therapy guidelines for these patients. In addition to a welltrained multi-disciplinary team, the following recommendations appear to improve outcomes: introducing nutrition therapy early; preferred enteral administration; appropriate energy intake; formulations that are tailored to specific patients, including appropriate nutrients; and strict electrolytic and metabolic monitoring. Understanding the pathophysiology and the consequences of therapy is fundamental.

show abstract

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 28 publications

References 22 publications

Untitled

Untitled

The prognostic significance of the timing of total enteral feeding in traumatic brain injury

Terapia nutricional no traumatismo cranioencefálico grave

Contact Info

Product

Resources

About