Abstract
Objective: To describe the pattern of energy expenditure during the first 30 days following traumatic brain injury (TBI). Data Sources: Medline, Embase, CINAHL, ISI Web of Science, and the Cochrane Library (1966 to December 2007). Study Selection: Trials that measured energy expenditure at least once during the first 30 days postinjury were included. Data Extraction: Data including patient characteristics, medical management, and details of metabolic measurements were abstracted independently by 2 reviewers. Results are reported descriptively. Data Synthesis: 24 studies were identified. During the first 30 days, mean energy expenditure expressed as a percentage of predicted value ranged from 75% to 200%. The lowest values were reported in patients admitted in brain death. The administration of paralyzing agents, sedatives, or barbiturates reduced metabolic rate by approximately 12% to 32%. Propranolol and morphine were also associated with smaller decreases in energy expenditure (5%, 8%, respectively). Steroid usage and method of feeding (enteral vs parenteral) did not appear to further elevate metabolic rate. It was unclear if elevated temperature, the presence of extracranial injury, or the severity of injury contributed further to hypermetabolism. Conclusions: Energy expenditure was significantly elevated in most patients following TBI, although the magnitude of the effect was highly variable.
Published Version
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