Nutritional management of the critically ill neurologic patient

To summarize, the event of severe neurologic injury results in significant metabolic changes. These changes cause increased requirements for protein and nonprotein calories, micronutrients, and small bowel feedings or TPN. Early feeding has been shown to improve survival. Therefore, every effort should be made to provide aggressive nutritional support within the first 72 hours after injury. Specific guidelines are as follows: Provide full-strength, full-rate feedings within 72 hours. Provide enteral nutrients via nasojejunal or percutaneous endoscopic jejunostomy feeding tube if access is available; attempt gastric feedings if not. Provide TPN within 48 hours if enteral access is not available and begin enteral feeding as soon as possible. Provide 2 to 2.3 g protein/kg/d if renal function is normal. Provide 40% to 70% above basal needs as total calories, with 30% to 40% of calories as lipid to minimize hyperglycemia. Provide protein as small peptides to improve tolerance, absorption, utilization, and gut integrity. Provide a lipid source with 50% to 70% medium-chain triglycerides and an omega-6 to omega-3 ratio of 2:1 to 8:1 to minimize negative effects of omega-6 fatty acids and provide an easily absorbed and utilized source of lipid.