Nutrition in the Neurocritical Care Unit: a New Frontier

Area of Science:

• Neurocritical care
• Clinical nutrition
• Metabolic research

Background:

• Acute neurologic injury triggers a pro-inflammatory, hypercatabolic state, increasing morbidity and mortality.
• Nutritional support is vital to counteract the effects of hypermetabolism in neurocritical patients.
• Existing evidence on feeding delivery outcomes in this population is inconsistent.

Purpose of the Study:

• To present current recommendations for nutrition in neurocritical care.
• To review updates on feeding initiation, immunonutrition, and metabolic substrates.
• To discuss ketogenic diets, cerebral microdialysis (CMD) monitoring, and microbiome considerations.

Main Methods:

• Literature review of current recommendations and emerging research areas.
• Synthesis of data on nutritional interventions for neurocritical care populations.
• Analysis of controversies and research gaps in neurocritical care nutrition.

Main Results:

• Limited evidence supports distinct feeding practices for neurocritical care patients.
• Emerging research areas include immunonutrition, pre/probiotics, ketogenic diets, and CMD monitoring.
• Standard polymeric formulas and early enteral nutrition are generally recommended.

Conclusions:

• Nutritional support is essential for mitigating hypermetabolism after neurologic injury.
• Heterogeneity in patients, interventions, and research complexity contribute to ongoing controversies.
• Further pragmatic and reproducible research is imperative to improve patient outcomes.