Nutritional Support in the Patient with Traumatic and Nontraumatic Brain Injury

Abstract

The multiple metabolic alterations following neurologic injuries create several unique challenges for clinicians providing nutrition support. The hypermetabolic and hypercatabolic state following traumatic brain injury (TBI) has been well studied over the past three decades. This review discusses several unique issues to incorporate into the nutrition support plan for both acute traumatic and nontraumatic brain injuries. The initial energy expenditure assessment varies drastically among the different neurologic injuries, from the lowest with anoxic brain injury and spinal cord injury to the highest with traumatic subdural hemorrhagic injury. Measuring energy expenditure with indirect calorimetry becomes a critical component of the assessment due to wide-ranging metabolic needs and effects from various drug therapies. An excess or a lack of adequate nutrition support clearly results in worse neurologic and nutrition status outcomes. The nutrition status and preexisting comorbidities of the neurologically injured patient further compound the complexity of the nutrition plan. Anticipating and correcting for refeeding syndrome in the malnourished stroke patient or alcoholic hypermetabolic TBI patient avoid further metabolic, cardiac, and ventilator complications. Fluid balance must be continuously monitored and hyperglycemia avoided to prevent cerebral edema. Planning and implementing an aggressive nutrition support regimen inclusive of drug therapy, appropriate fluid status, electrolyte replacement, and close glucose monitoring incorporate the expertise of several health care disciplines to ensure optimal outcomes from the critical care setting. Nutrition support plans become one of the primary focuses during recovery following a neurologic injury. Proper swallow assessments and techniques to recognize dysphagia and avoid aspiration and its complications with pneumonia become paramount during the stroke rehabilitation phase. Due to the variety of acute neurologic injuries, health care providers must address each of the distinctive issues for an individualized nutrition support therapy to ensure optimal outcomes and minimize complications This review contains 1 figure, 4 tables, and 58 references.