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Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries
G Minard1, K A Kudsk, S Melton
1Department of Surgery, The University of Tennessee, Memphis, USA. gminard@utmem.edu
Insights
Early enteral nutrition did not significantly alter outcomes or infectious complications in severe closed-head injury patients. However, head injury severity was linked to increased infection risk.
Area of Science:
- Trauma critical care
- Neurocritical care
- Nutritional support
Background:
- Early enteral feeding is beneficial for trauma patients, but its impact on severe closed-head injuries remains unclear.
- Conflicting data exists regarding the optimal timing of nutritional support in patients with severe closed-head injuries.
Purpose of the Study:
- To investigate the effects of early versus delayed enteral nutrition on patient outcomes.
- To assess the impact of nutritional timing on length of stay, infectious complications, and neurological recovery in severe closed-head injury patients.
Main Methods:
- Prospective randomized study of 30 severe closed-head injury patients (Glasgow Coma Scale [GCS] 4-10).
- Patients received either early (<72 hours) or delayed enteral feeding with an immune-enhancing formula.
- Nutritional goals were 21 nonprotein cal/kg/d and 0.3 g N/kg/d.
Main Results:
- No significant differences in length of stay, ICU days, or infectious complications between early and delayed feeding groups.
- Mortality was 1/15 in the early group and 4/12 in the late group (not statistically significant).
- Major infection correlated inversely with admission GCS score, and patients with infections had longer times to reach a GCS score of 14.
Conclusions:
- Early enteral feeding with an immune-enhancing formula does not appear to improve outcomes or reduce infectious complications in severe closed-head injury patients.
- The severity of the head injury is a significant factor associated with infectious complications.
- Further research may be needed to clarify the role of nutritional support in this patient population.
Background:
Although early enteral feeding clearly reduces septic morbidity after blunt and penetrating trauma, data for head-injured patients are conflicting. This study examines the effects of early vs delayed enteral feedings on outcome in patients with severe closed-head injuries with a Glasgow Coma Scale (GCS) score greater than 3 and less than 11.
Methods:
Thirty patients were prospectively randomized to receive an immune-enhancing diet (Impact with fiber) early (initiated < 72 hours after trauma) delivered via an endoscopically placed nasoenteric tube (Stay-Put) or late (administered after gastric ileus resolved). This formula was continued for 14 days or until the patient tolerated oral feeding. Goal rate of nutrition was 21 nonprotein cal/kg/d and 0.3 g N/kg/d.
Results:
Two patients in the early group were excluded due to inability to place the tube, and one patient in the late group died before 72 hours. Five of the remaining 27 died, 1 in the early group and 4 in the late group. There were no significant differences between the groups in length of stay, intensive care unit (ICU) days, significant infection, or GCS score. However, major infection correlated inversely with admission GCS score (R = -0.6, p < .003). Time to reach a GCS score of 14 was significantly longer in patients with significant infections compared with those without (p < .02).
Conclusions:
No difference in length of stay or infectious complications is shown in patients with severe closed-head injury when they are given early vs delayed feeding using an immune-enhancing formula. Severity of the head injury is closely associated with significant infection.
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