Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2016; 03(04): S70-S76
DOI: 10.4103/2348-0548.174741
Conference Proceeding
Thieme Medical and Scientific Publishers Private Ltd.

Nutrition in neuro-intensive care and outcomes

Prasanna U. Bidkar
1   Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India
› Author Affiliations
Further Information

Publication History

Publication Date:
05 May 2018 (online)

Also available at
   Permissions and Reprints

INTRODUCTION

The aim of nutrition is to supply nutritional needs of the critically ill patients. The patients who are seriously ill are prone to malnutrition owing to nausea, vomiting, dysphagia, poor mentation and mechanical ventilation. Patients with the head injury, stroke, brain tumours, acute spinal cord injury, and neurologic and neuromuscular disorders are the typical group of patients admitted to Neuro-Intensive Care Units (ICUs). These patients often require non-enteral nutrition owing to dysphagia, poor neurological status and mechanical ventilation. These patients are at risk for malnutrition due to hypercatabolism owing to the disease process, reduced oral intake, visceral protein loss and wasting of muscles due to immobility. A good nutrition supplementation can improve immunity, morbidity and mortality and length of hospital stay.[1]

Over the past several years, there is increasing emphasis on early nutritional therapy to all critically ill patients.[2] [3] Early enteral feeding has been shown to reduce catabolism and reduce complications and hence can reduce the length of hospital stay and morbidity and mortality in critically ill neurological patients. The benefits of early enteral feeding are more when the therapy initiated within 48–72 h of neurological insult.[3] [4] However, many neuro physicians and surgeons hesitate to start early nutrition therapy in these patients. Even the patients with silent abdomen can tolerate low jejunal feeds when initiated as early as 36 h post-injury.[5] However, many questions remain unanswered in neurologically ill patients, due to lack of precise clinical trials.

  • Timing of intervention: Early versus delayed initiation of nutritional therapy and their effect on poor outcome and mortality

  • Enteral versus parenteral nutrition and their effect on poor outcome and mortality

  • Enteral nutrition: Jejunal versus gastric feeding and their effect on poor outcome and mortality

  • Use of immunomodulating agents and effect on the outcome.

The present article focuses on the nutrition in traumatic brain injury (TBI) patients and its effect on outcomes in Neuro-ICUs and a small note on nutrition in patients with stroke.

 

  • REFERENCES

  • 1 Young B, Ott L, Twyman D, Norton J, Rapp R, Tibbs P. et al. The effect of nutritional support on outcome from severe head injury. J Neurosurg 1987; 67: 668-76
    CrossrefPubMedGoogle Scholar
  • 2 Minard G, Kudsk KA. Is early feeding beneficial?. How early is early? New Horiz 1994; 2: 156-63
    PubMedGoogle Scholar
  • 3 Nyswonger GD, Helmchen RH. Early enteral nutrition and length of stay in stroke patients. J Neurosci Nurs 1992; 24: 220-3
    CrossrefPubMedGoogle Scholar
  • 4 Minard G, Kudsk KA, Melton S, Patton JH, Tolley EA. Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries. JPEN J Parenter Enteral Nutr 2000; 24: 145-9
    CrossrefPubMedGoogle Scholar
  • 5 Kirby DF, Clifton GL, Turner H, Marion DW, Barrett J, Gruemer HD. Early enteral nutrition after brain injury by percutaneous endoscopic gastrojejunostomy. JPEN J Parenter Enteral Nutr 1991; 15: 298-302
    CrossrefPubMedGoogle Scholar
  • 6 Brealey D, Singer M. Multi-organ dysfunction in the critically ill: Effects on different organs. J R Coll Physicians Lond 2000; 34: 428-31
    PubMedGoogle Scholar
  • 7 Tripathy S. Nutrition in the neurocritical care unit. J Neuroanaesth Crit Care 2015; 2: 88-96
    PubMedGoogle Scholar
  • 8 Hillhouse JH, Neiger R. Pregnancy and lactation. In: Gottschlich MM, Fuhrman MP, Hammond KA, Holcombe BJ, Seidner DL. editors. The Science and Practice of Nutrition Support: A Case-Based Core Curriculum. Dubuque, IA: Kendall/Hunt Publishing Company; 2001. p. 302-19
    Google Scholar
  • 9 Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS. Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF. et al. Guidelines for the management of severe traumatic brain injury. XII. Nutrition. J Neurotrauma 2007; 24 Suppl (Suppl. 01) S77-82
    CrossrefPubMedGoogle Scholar
  • 10 Rapp RP, Young B, Twyman D, Bivins BA, Haack D, Tibbs PA. et al. The favorable effect of early parenteral feeding on survival in head-injured patients. J Neurosurg 1983; 58: 906-12
    CrossrefPubMedGoogle Scholar
  • 11 Young B, Ott L, Haack D, Twyman D, Combs D, Oexmann JB. et al. Effect of total parenteral nutrition upon intracranial pressure in severe head injury. J Neurosurg 1987; 67: 76-80
    CrossrefPubMedGoogle Scholar
  • 12 Grahm TW, Zadrozny DB, Harrington T. The benefits of early jejunal hyperalimentation in the head-injured patient. Neurosurgery 1989; 25: 729-35
    CrossrefPubMedGoogle Scholar
  • 13 Taylor SJ, Fettes SB, Jewkes C, Nelson RJ. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Crit Care Med 1999; 27: 2525-31
    CrossrefPubMedGoogle Scholar
  • 14 Härtl R, Gerber LM, Ni Q, Ghajar J. Effect of early nutrition on deaths due to severe traumatic brain injury. J Neurosurg 2008; 109: 50-6
    CrossrefPubMedGoogle Scholar
  • 15 Dhandapani S, Dhandapani M, Agarwal M, Chutani AM, Subbiah V, Sharma BS. et al. The prognostic significance of the timing of total enteral feeding in traumatic brain injury. Surg Neurol Int 2012; 3: 31
    CrossrefPubMedGoogle Scholar
  • 16 Chiang YH, Chao DP, Chu SF, Lin HW, Huang SY, Yeh YS. et al. Early enteral nutrition and clinical outcomes of severe traumatic brain injury patients in acute stage: A multi-center cohort study. J Neurotrauma 2012; 29: 75-80
    CrossrefPubMedGoogle Scholar
  • 17 Chourdakis M, Kraus MM, Tzellos T, Sardeli C, Peftoulidou M, Vassilakos D. et al. Effect of early compared with delayed enteral nutrition on endocrine function in patients with traumatic brain injury: An open-labeled randomized trial. JPEN J Parenter Enteral Nutr 2012; 36: 108-16
    CrossrefPubMedGoogle Scholar
  • 18 Perel P, Yanagawa T, Bunn F, Roberts I, Wentz R, Pierro A. Nutritional support for head-injured patients. Cochrane Database Syst Rev. 2006 CD001530
    PubMedGoogle Scholar
  • 19 Wang X, Dong Y, Han X, Qi XQ, Huang CG, Hou LJ. Nutritional support for patients sustaining traumatic brain injury: A systematic review and meta-analysis of prospective studies. PLoS One 2013; 8: e58838
    CrossrefPubMedGoogle Scholar
  • 20 Hadley MN, Grahm TW, Harrington T, Schiller WR, McDermott MK, Posillico DB. Nutritional support and neurotrauma: A critical review of early nutrition in forty-five acute head injury patients. Neurosurgery 1986; 19: 367-73
    CrossrefPubMedGoogle Scholar
  • 21 Borzotta AP, Pennings J, Papasadero B, Paxton J, Mardesic S, Borzotta R. et al. Enteral versus parenteral nutrition after severe closed head injury. J Trauma 1994; 37: 459-68
    CrossrefPubMedGoogle Scholar
  • 22 Justo Meirelles CM, de Aguilar-Nascimento JE. Enteral or parenteral nutrition in traumatic brain injury: A prospective randomised trial. Nutr Hosp 2011; 26: 1120-4
    PubMedGoogle Scholar
  • 23 Kostadima E, Kaditis AG, Alexopoulos EI, Zakynthinos E, Sfyras D. Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients. Eur Respir J 2005; 26: 106-11
    CrossrefPubMedGoogle Scholar
  • 24 Acosta-Escribano J, Fernández-Vivas M, Grau Carmona T, Caturla-Such J, Garcia-Martinez M, Menendez-Mainer A. et al. Gastric versus transpyloric feeding in severe traumatic brain injury: A prospective, randomized trial. Intensive Care Med 2010; 36: 1532-9
    CrossrefPubMedGoogle Scholar
  • 25 Wang D, Zheng SQ, Chen XC, Jiang SW, Chen HB. et al. Comparisons between small intestinal and gastric feeding in severe traumatic brain injury: A systematic review and meta-analysis of randomized controlled trials. J Neurosurg. 2015: 1-8
    PubMedGoogle Scholar
  • 26 Falcão de Arruda IS, de Aguilar-Nascimento JE. Benefits of early enteral nutrition with glutamine and probiotics in brain injury patients. Clin Sci (Lond) 2004; 106: 287-92
    CrossrefPubMedGoogle Scholar
  • 27 Briassoulis G, Filippou O, Kanariou M, Papassotiriou I, Hatzis T. Temporal nutritional and inflammatory changes in children with severe head injury fed a regular or an immune-enhancing diet: A randomized, controlled trial. Pediatr Crit Care Med 2006; 7: 56-62
    CrossrefPubMedGoogle Scholar
  • 28 Khorana J, Rerkasem K, Apichartpiyakul C, Sakonwasun C, Watcharasakslip W, Waniyapong T. et al. Immunonutrition and cytokine response in patients with head injury. J Med Assoc Thai 2009; 92: 188-94
    PubMedGoogle Scholar
  • 29 Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: Prognosis and prognostic factors at 6 months. Stroke 1999; 30: 744-8
    CrossrefPubMedGoogle Scholar
  • 30 Hilker R, Poetter C, Findeisen N, Sobesky J, Jacobs A, Neveling M. et al. Nosocomial pneumonia after acute stroke: Implications for neurological intensive care medicine. Stroke 2003; 34: 975-81
    CrossrefPubMedGoogle Scholar
  • 31 Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol 1994; 51: 1051-3
    CrossrefPubMedGoogle Scholar
  • 32 DePippo KL, Holas MA, Reding MJ. Validation of the 3-oz water swallow test for aspiration following stroke. Arch Neurol 1992; 49: 1259-61
    CrossrefPubMedGoogle Scholar
  • 33 Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A. et al. Dysphagia bedside screening for acute-stroke patients: The Gugging Swallowing Screen. Stroke 2007; 38: 2948-52
    CrossrefPubMedGoogle Scholar
  • 34 Warnecke T, Teismann I, Meimann W, Olenberg S, Zimmermann J, Krämer C. et al. Assessment of aspiration risk in acute ischaemic stroke – Evaluation of the simple swallowing provocation test. J Neurol Neurosurg Psychiatry 2008; 79: 312-4
    CrossrefPubMedGoogle Scholar
  • 35 Bours GJ, Speyer R, Lemmens J, Limburg M, de Wit R. Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: Systematic review. J Adv Nurs 2009; 65: 477-93
    CrossrefPubMedGoogle Scholar
  • 36 Warnecke T, Teismann I, Oelenberg S, Hamacher C, Ringelstein EB, Schäbitz WR. et al. The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke 2009; 40: 482-6
    CrossrefPubMedGoogle Scholar
  • 37 Stratton R, Green CJ, Elia M. Disease-related Malnutrition. An Evidence Based Approach to Treatment. CABI Publishing; 2003
    Google Scholar
  • 38 Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteraltube feeding for dysphagic stroke patients (FOOD): A multicenter randomised controlled trial. Lancet 2005; 365: 764-72
    CrossrefPubMedGoogle Scholar
  • 39 Dennis M, Lewis S, Cranswick G, Forbes J. FOOD: A multicentre randomized trial evaluating feeding policies in patients admitted to hospital with arecent stroke. Health Technol Assess 2006; 10: 1-120
    PubMedGoogle Scholar