[Gastric enteral intolerance in mechanically ventilated patients with traumatic cerebral lesion]

To check the correlation between gastric intolerance and hypertension intracranial pressure and their association with the clinical parameters and severity indexes in patients with severe head injury (HI); to evaluate the advantages of transpyloric feeding.

Prospective and observational clinical study.

Intensive Care Unit (ICM) of a General University Hospital.

25 brain injured patients requiring sedation, mechanical ventilation and hypertensión intracranial monitoring.

Analysis of the incidence of delayed gastric emptying (area under the curve (AUC60)) and of gastrointestinal intolerance; study of their correlation with hypertension intracranial, severity indexes and sedative medication administered; evaluation of the alternative effectiveness of transpyloric feeding.

44% of the patients showed GI, which was measured by means of the paracetamol test (AUC60). The sedative medication was related to IG (p < 0.005), HIC (p < 0.01) and AUC60 (p < 0.01). Of the severity indexes, there was a correlation between Glasgow Coma Score and AUC60 (p < 0.01); the Marshall score HIC (p < 0.005) and AUC60 (p < 0.01). Of the quantitative variables, we found a correlation between HIC and IG (p < 0.001), HIC and pneumonia (p < 0.01), IG as well pneumonia (p < 0.001), and AUC60 (p < 0.001) and AUC60 and pneumonia (p < 0.05).

Enteral intolerance in patients with HI is due to delayed gastric emptying (DGE) which is proportional to the severity of the head injury and to the intensity of the systemic response. The high incidence of GI makes transpyloric feeding advisable in order to attain the nutritional objective and to reduce the risk of aspirative nosocomial pneumonia.