Nutrition in the head-injured patient

Neurologic injury initiates a cascade of local and systemic metabolic responses. Patients become hypermetabolic, hypercatabolic, and hyperglycemic and develop decreased immune competency and altered gastrointestinal function. Provision of an adequate supply of nutrients is associated with improved outcome. Because of the high incidence of gastroparesis, enteral nutritional support of patients with acute head injury has traditionally been difficult and led to frequent use of parenteral nutrition. New methods of early enteral feeding allow a majority of these patients to receive adequate nutrition via the enteral route. Evidence indicates that early small bowel feeding of patients with acute head injury results in a decreased incidence of infections and shorter ICU stay. The roles of specific nutrients in modulating injury responses are currently being evaluated. The optimal nutritional support for improving neurologic recovery following head injury remains to be established.