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Published on: September 19, 2019
Early feeds not force feeds: Enteral nutrition in traumatic brain injury
Asad Azim1, Ansab A Haider, Peter Rhee
1From the Division of Trauma, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson, Arizona.
Insights
Early enteral nutrition after traumatic brain injury (TBI) may increase pneumonia risk and ICU length of stay. While not improving mortality, these early feeds warrant careful consideration in TBI patient management.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Clinical Nutrition
Background:
- Brain Trauma Foundation guidelines advocate early enteral nutrition for traumatic brain injury (TBI) recovery.
- The study investigates the clinical impact of initiating enteral nutrition within 24 hours post-TBI.
Purpose of the Study:
- To evaluate the effect of early enteral feeding (≤24 hours) on clinical outcomes in severe TBI patients.
- To compare outcomes between patients receiving early versus late tube feeds.
Main Methods:
- Retrospective analysis of 90 severe TBI patients (Glasgow Coma Scale score <8) admitted to the ICU.
- Categorization into early tube feeds (≤24 hours) and late tube feeds (>24 hours).
- Outcome assessment included pneumonia rates, ventilator days, ICU/hospital stay, and mortality.
Main Results:
- Early tube feeds were associated with a higher number of ICU days (p=0.03) and increased pneumonia rates (p=0.04).
- No significant difference in mortality rates was observed between early and late feeding groups (p=0.44).
- Patient demographics including age, head injury severity, and admission Glasgow Coma Scale score were similar between groups.
Conclusions:
- Despite recommendations, early enteral feeding in TBI patients correlated with higher pneumonia rates and increased hospital resource utilization.
- The findings suggest a need for careful evaluation of early feeding protocols in TBI management to balance potential benefits against risks like infection and resource use.
Background:
Brain Trauma Foundation guidelines recommend the early use of enteral nutrition to optimize recovery following traumatic brain injury (TBI). Our aim was to examine the effect of early feeds (≤24 hours) on clinical outcomes after TBI.
Methods:
We performed a 3-year retrospective study of patients with severe TBI (Glasgow Coma Scale score <8) who were intubated, admitted to the intensive care unit (ICU), and received tube feeds. Early tube feeds (early TF) were defined as initiation of tube feeds within 24 hours, whereas late tube feeds (late TF) were defined as initiation of tube feeds after 24 hours. Outcome measures included pneumonia rates, days on ventilator, hospital and ICU stay, and mortality rates.
Results:
A total of 90 patients (early TF: 58, late TF: 32) were included, of which 73.3% were male, mean age was 42 (SD, 20) years, and median head Abbreviated Injury Scale score was 4 (range, 3-5). There was no difference in age (p = 0.1), head Abbreviated Injury Scale score (p = 0.5), or admission Glasgow Coma Scale score (p = 0.9) between the two groups. Patients with early TF were associated with higher number of ICU days (p = 0.03) and higher pneumonia rates (p = 0.04), but there was no significant difference in mortality (p = 0.44) as compared with those who underwent late TF.
Conclusions:
Although early tube feeds are known to improve outcomes in TBI patients, our data suggest that early feeds in TBI patients are associated with higher rates of pneumonia and greater hospital resource utilization.
Level Of Evidence:
Therapeutic study, level IV.
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