Nutrition in neuro-intensive care and outcomes

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.

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