Patterns of Enteral Feeding, Feeding Intolerance, and Mortality in Traumatic Brain Injury: An Observational Study

Area of Science:

• Critical Care Medicine
• Neuroscience
• Nutritional Support

Background:

• Traumatic brain injury (TBI) patients often suffer from underfeeding and enteral feeding (EF) intolerance.
• Optimal timing and caloric delivery via EF in TBI patients remain critical areas of investigation.

Purpose of the Study:

• To investigate the association between the timing of enteral feeding (EF), achieved caloric intake, EF intolerance, and mortality in moderate-to-severe TBI patients.
• To determine if early initiation of EF impacts patient outcomes in the intensive care unit (ICU).

Main Methods:

• Retrospective analysis of adult patients with moderate-to-severe TBI admitted to a tertiary-care ICU.
• Recording daily caloric intake from EF and incidence of EF intolerance (defined by gastric residual volume or vomiting) within the first 7 days post-ICU admission.
• Multivariable logistic regression analysis to identify independent predictors of mortality.

Main Results:

• Early EF (within 48 hours) was initiated in 70.4% of patients, leading to significantly higher median 7-day caloric intake (64.7% vs. 23.1% of requirement) compared to late EF.
• EF intolerance occurred in only 8.1% of patients, with no significant difference between early and late EF groups.
• Early EF was associated with significantly lower hospital mortality (13.8% vs. 30.7%), adequate caloric intake (≥80% requirement) with lower mortality (8.5% vs. 21.3%), and EF intolerance with higher mortality (50% vs. 16.1%).

Conclusions:

• Early enteral feeding in moderate-to-severe TBI patients is associated with improved caloric delivery and reduced hospital mortality.
• Enteral feeding intolerance, though infrequent, is a significant independent predictor of increased mortality in TBI patients.
• Initiating EF early in TBI management is a crucial strategy for improving patient outcomes and reducing mortality in the ICU setting.