Comparison of enteral nutrition by nasointestinal tube and nasogastric tube on aspiration pneumonia and intestinal mucosal barrier function in patients with severe traumatic brain injury

Abstract

Objective To compare and explore the optimal pathway of enteral nutrition between nasointestinal tube and nasogastric tube in patients with severe traumatic brain injury (sTBI). Methods One hunderd patients with sTBI, admitted to our hospital from January 2016 to December 2016, were divided into nasointestinal tube group and nasogastric tube group (n=50) according to different enteral nutrition pathways. The serum levels of tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 were tested with enzyme linked immunosorbent assay (ELISA). Meanwhile, intestinal mucosal barrier function indexes D-lactate acid and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method. On the admission, and one, 3, 7 and 14 d after treatment, gastrointestina complications, pneumonias and prognoses of the two groups were compared. Results As compared with those in the nasogastric tube group, the serum levels of inflammatory related factors (TNF-α and IL-6) in the nasointestinal tube group were significantly decreased 3 d after treatment (TNF-α: [112.77±14.52] μg/L vs. [163.16±18.85] μg/L P=0.01; IL-6: [80.11±8.02] μg/L vs. [100.97±9.82], P=0.02). As compared with those in the nasogastric tube group, the intestinal mucosal barrier function indexes (D-lactate acid and I-FABP) in the nasointestinal tube group were significantly decreased 7 d after treatment (D-lactate: [47.51±4.87] μg/L vs. [62.20±6.01] μg/L, P=0.04; I-FABP: [29.12±3.74] μg/L vs.[40.08±5.51] μg/L, P=0.01). The nasointestinal tube group had significantly lower gastric retention incidence (18% vs. 28%, P=0.00) and aspiration incidence (14% vs. 26%, P=0.06). Meanwhile, the nasointestinal tube group had significantly lower incidence of pneumonia (24% vs. 34%, P=0.01), reduced pneumonia severity (clinical pulmonary infection scores [CPIS]: 14.27±1.22 vs. 17.30±1.50, P=0.03), better prognosis (GCS scores: (9.41±0.66 vs. 8.23±0.57, P=0.03; APACHE II scores: 14.27±1.22 vs. 17.30±1.50, P=0.03) 14 d after treatment as compared with the nasogastric tube group. Enteral nutrition by nasointestinal tube could shorten the hospitalization days of patients (18.52±2.00 vs. 24.82±2.31, P=0.02). Conclusion Enteral nutrition by nasointestinal tube can effectively reduce the incidences of gastrointestinal and pulmonary complications, and alleviate inflammatory response and intestinal mucosal barrier function damage in patients with sTBI, possibly improving prognosis. Key words: Severe traumatic brain injury; Enteral nutrition; Nasointestinal tube; Nasogastric tube