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Early Adequate Nutrition in ICU Is Associated with Survival Gain : Retrospective Cohort Study in Patient with
Junseo Oh1, Jingyeong Kim1, Jihyeon Ahn2
1Department of Pharmacy, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
Insights
Early nutritional support, especially adequate calorie intake, improves survival rates in patients with traumatic brain injury (TBI). Sufficient nutrition is crucial for better outcomes in TBI intensive care unit (ICU) patients.
Area of Science:
- Intensive Care Medicine
- Neurocritical Care
- Trauma Surgery
Background:
- Traumatic brain injury (TBI) patients often suffer malnutrition due to feeding difficulties, impacting their prognosis.
- Early nutritional support in the intensive care unit (ICU) for TBI patients lacks sufficient evidence.
- Malnutrition and aspiration pneumonia are common complications in TBI patients.
Purpose of the Study:
- To assess the impact of early nutritional support on the outcomes of TBI patients admitted to the ICU.
- To identify risk factors for mortality in TBI patients receiving nutritional support.
- To evaluate the relationship between nutritional intake and survival in TBI patients.
Main Methods:
- Retrospective analysis of adult TBI patients admitted to a trauma ICU between 2022-2023.
- Exclusion criteria included ICU stay <7 days, age <18, and pre-existing metabolic conditions.
- Nutritional support on day 4 was measured; patients were grouped by mortality and survival, with subgroup analysis by TBI severity.
Main Results:
- Of 227 TBI patients, 15% (n=34) died. Survivors were younger, had longer stays, higher initial Glasgow Coma Scale (GCS) scores, and higher calorie supplement intake.
- In non-severe TBI (GCS >8), survivors had significantly higher total calorie (751.4 vs. 434.2 kcal) and protein intake (37.5 vs. 22.1 g).
- Calorie intake and initial hemoglobin levels were identified as risk factors for mortality in non-severe TBI patients.
Conclusions:
- Increased calorie supply was associated with reduced mortality in non-severe TBI patients.
- While protein intake was lower in the mortality group, it was not a significant risk factor.
- Early and sufficient nutritional support, particularly adequate calorie provision, is vital for improving TBI patient prognosis.
Objective:
Patients with traumatic brain injury (TBI) commonly exhibit a poor mental health status and can easily develop aspiration pneumonia. Thus, early proper nutrition through oral or tube feeding is difficult to achieve, leading to malnutrition. However, evidence regarding early nutritional support in the intensive care unit (ICU) is lacking. We aimed to assess the effect of early nutrition in patients with TBI admitted to the ICU.
Methods:
Data of adult patients with TBI admitted to the trauma ICU of a regional trauma center in Korea between 2022 and 2023 were retrospectively analyzed. Those with ICU stay <7 days, younger than 18 years, and with underlying diseases that could alter baseline metabolism, were excluded. Nutritional support on day 4 of ICU admission was measured. The patients were classified into mortality and survival groups, and risk factors for mortality were evaluated. Subgroup analyses were performed based on TBI severity.
Results:
Overall, 864 patients were diagnosed with acute TBI, of whom 227 were included in this study. The mortality rate in the study population was 15% (n=34). Those in the survival group were younger, had longer hospital stays, had a higher initial Glasglow coma scale (GCS) score, and had a higher intake of calorie supplements than those in the mortality group. In a subgroup analysis of patients with non-severe TBI (GCS >8), total calorie intake (751.4 vs. 434.2 kcal, p=0.029), total protein intake (37.5 vs. 22.1 g, p=0.045), and ratio of supplied to target calories (0.49 vs. 0.30, p=0.047) were higher in the survival group than in the mortality group. Logistic regression analysis revealed that calorie intake (B=-0.002, p=0.040) and initial hemoglobin level (B=-0.394, p=0.005) were risk factors for mortality in patients with non-severe TBI.
Conclusion:
More calories were supplied to the survival group than the mortality group among patients with TBI. Additionally, logistic regression analysis showed that increased calorie supply was associated with reduced mortality in patients with non-severe TBI. The mortality group had low protein intake; however, this did not emerge as a risk factor for mortality. Early sufficient nutritional support improves the prognosis of patients with TBI.
