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Enteral nutrition

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).

Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, 4th Ed. Neurosurgery. 2017;80(1):6-15.
Chourdakis M, Kraus MM, Tzellos T, et al. Effect of early compared with delayed enteral nutrition on endocrine function in patients with traumatic brain injury:an open- labeled randomized trial. J Parenter Enteral Nutr. 2012;36(1):108-116.
Dhandapani S, Dhandapani M, Agarawal M, et al. The prognositc significance of the timing of total enteral feeding in traumatic brain injury. Surg Neurol Int. 2012;3:31-36.
Acosta-Escribano J, Fernandez-Vivas M, Grau CT, et al. Gastric versus transpyloric feeding in severe traumatic brain injury: a prospective, randomized trial. Intensive Care Med. 2010;36(9):1532-1539.
Lepelletier D, Roquilly A, Demeure DL, et al. Retrospective analysis of the risk factors and pathogens associated with early-onset ventilator-associated pneumonia in surgical- ICU head-trauma patients. J Neurosurg Anesthesiol. 2010;22(1):32-37.
Hartl R, Gerber LM, Ni Q, Ghajar J. Effect of early nutrition on deaths due to severe traumatic brain injury. J Neurosurg. 2008;109(1):50-56
Jeter CB, Hergenroeder GW, Ward NH, et al. Human mild traumatic brain injury decreases circulating branched-chain amino acids and their metabolite levels. J Neurotrauma. 2013;15(8):671-679.
Elkind JA, Lim MM, Johnson BN, et al. Efficacy, dosage, and duration of action of branched chain amino acid therapy for traumatic brain injury. Front Neurol. 2015;30:66-73.
Sharma B, Lawrence DW, Hutchison MG. Branched chain amino acids (BCAAs) and traumatic brain injury: a systematic review. J Head Trauma Rehabil. 2017. doi: 10.1097/HTR.0000000000000280.
enteral_nutrition.txt · Last modified: 2017/10/24 16:40 by administrador