The nutritional management of patients with head injuries

Neurological Research
R F WilsonJ G Tyburski

Abstract

Severe head injuries tend to be associated with hypermetabolism and hypercatabolism resulting in negative nitrogen balances which may exceed 30 grams day-1. Enteral feeding should begin as soon as the patient is hemodynamically stable, attempting to reach a non-protein caloric intake of at least 30-35 kcal kg-1 day-1 and a protein intake of 2.0-2.5 g kg-1 day-1 as soon as possible. With severe head injuries (Glasgow Coma Scale < 8), there is an increased tendency for gastric feeding to regurgitate into the upper airway. Keeping the patient upright and checking residuals is important in such patients. Jejunal feedings are less apt to be aspirated. If it is apparent that the gastro-intestinal tract cannot be used to reach the nutritional goals within three days, total parental nutrition is begun within 24-48 h so as to reach these nutrition goals by either one or both routes by the third or fourth day. Blood glucose levels exceeding 150-200 mg dl-1 tend to increase the severity of the neurologic problems and efforts should be made to prevent hyperglycemia by carefully regulating the glucose and insulin intake. Indirect calorimetry to determine the respiratory quotient and resting energy expenditure should be determined twice week...Continue Reading

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Citations

Apr 17, 2004·Journal of Neurosurgery·Juergen BardutzkyStefan Schwab
Jul 8, 2010·Journal of Emergencies, Trauma, and Shock·Sabita JivnaniM A Gore
Jun 29, 2010·Nutrition·Angela Vizzini, Jaime Aranda-Michel
Jan 16, 2010·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·A A AdeoluO A Adegoke
Aug 8, 2006·Nutrition·Christophe MoinardChristine Charrueau
Jul 26, 2015·International Journal of Surgery·Thomas J PainterRodrigo F Alban
Oct 19, 2006·JPEN. Journal of Parenteral and Enteral Nutrition·Grant V BochicchioThomas M Scalea

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