Enteral feeding tubes may be placed in the stomach (gastric tube feeding) or in the upper small bowel (transpyloric tube feeding). There are potential advantages and disadvantages to both routes.
In review of the nutritional guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition, the articles cited demonstrate early transpyloric enteral feeds within 24 to 48 h significantly decrease morbidity and mortality 1) 2) 3) 4) 5) 6).
While these articles provide clear evidence that early nutrition is critical to survival, the most recent cited reference is 2012 and the articles lack the detail of which specific macro/micronutrients may benefit the traumatized brain. This is not a critique of the authors creating the guidelines but rather an observation of the need for serious large multi-institutional nutritional studies on TBI. Recently, there have been several studies demonstrating the highly beneficial effects of branched chain aminoacids (BCAAs) in the patient suffering mild to severe brain injury 7) 8) 9).