Nutrition, Antibiotics, and Post-traumatic Seizure Prophylaxis

Abstract

In the trauma intensive care setting, the delivery of adequate nutrition is a daily concern. Early enteral feeding is beneficial for multi-trauma patients and those with traumatic brain injury. However, assessment of a patient’s nutritional status at any given point in time is challenging because of the low specificity of available nutritional markers. It is also difficult to measure a patient’s response to nutritional interventions. Low calorie, high protein feeding is recommended to meet the nutritional needs and catabolic demands of critically ill trauma patients. Antibiotic use is extremely common in the ICU setting, for both prophylactic and therapeutic purposes. In recent years, the alarming increase in the prevalence of multi-drug-resistant microorganisms and virulent pathogens makes antibiotic stewardship a vital component of safe, effective critical care delivery. Here we discuss the use of prophylactic antibiotics in conjunction with the placement of intracranial pressure monitors and external ventricular drains in neurotrauma patients. Patients with traumatic brain injury are at risk for post-traumatic seizures. Antiepileptic drugs are commonly employed as prophylaxis against post-traumatic seizures in certain patients, based on evidence indicating a decreased rate of early, but not late seizures with prophylaxis. Past research has examined broad populations that included a wide variety of traumatic pathology, possibly leading to an over generalization in the application of these medications. A critical appraisal of the existing evidence for seizure prophylaxis in neurotrauma patients is presented.