Variation in metabolic demand following severe pediatric traumatic brain injury: A case review

Abstract

A traumatic brain injury (TBI) is one of the most common pediatric traumas among children in the United States. Appropriate nutrition support, including the initiation of early enteral nutrition, within the first 48 h after injury is crucial for children with a TBI. It is important that clinicians avoid both underfeeding and overfeeding, as both can lead to poor outcomes. However, the variable metabolic response to a TBI can make determining appropriate nutrition support difficult. Because of the dynamic metabolic demand, indirect calorimetry (IC) is recommended, instead of predictive equations, to measure energy requirements. Although IC is suggested and ideal, few hospitals have the technology available. This case review discusses the variable metabolic response, identified using IC, in a child with a severe TBI. The case report highlights the ability of the team to meet measured energy requirements early, even in the setting of fluid overload. It also highlights the presumed positive impact of early and appropriate nutrition provision on the patient's clinical and functional recovery. Further research is needed to investigate the metabolic response to TBIs in children and the impact optimal feedings based on the measured resting energy expenditure have on clinical, functional, and rehabilitation outcomes.

Cuidados de enfermería en pacientes críticos con trauma cráneo encefálico severo

“…Las decisiones sobre el manejo de la temperatura en los pacientes con TCEG ha sido debatida abordando tres cuestiones principales: el uso de la hipotermia terapéutica como intervención neuroprotectora, el uso de la hipotermia como tratamiento de la hipertensión intracraneal y la prevención de la hipertermia, es decir, controlar de manera exhaustiva la temperatura. Una recapitulación de los últimos avances en la investigación clínica y experimental ha concluido que el uso de la hipotermia terapéutica como intervención neuroprotectora no es útil en el paciente con TCEG 15 .…”