Nutrition in neurologic and neurosurgical critical care

Till recently little attention was paid to the nutritional and metabolic management of the neurologic patient. The effect of brain insult on metabolic and nutritional demands has only recently been studied extensively. Patients with head injury suffer a systemic metabolic response to stress consisting of hypermetabolism/hypercatabolism, hyperglycemia, acute phase response, and immune system alterations. The cause of these abnormalities is probably multifactorial. Resting energy expenditure (REE) increases following closed head injury. Until recently nutritional management was not considered in the medical treatment of these patients. Several studies have proved that adequate nutritional support decreases mortality and morbidity. Enteral nutrition is proved to accelerate normalization of nutritional status and to improve substance tolerance.