Early Gastric Feeding Following Traumatic Brain Injury Improves Likelihood for Survival

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Title: Early Gastric Feeding Following Traumatic Brain Injury Improves Likelihood for Survival
URL: http://www.pslgroup.com/dg/224C3A.htm
Doctor's Guide
July 2, 2008

NEW YORK -- July 2, 2008 -- Patients with traumatic brain injury (TBI) that receive nutritional supplementation through a gastric feeding tube as soon as possible can have an improved chance of survival by as much as 4-fold, according to new research published in the July issue of the Journal of Neurosurgery.

Clinician-scientists from NewYork-Presbyterian Hospital/Weill Cornell Medical Center are suggesting an immediate and important change to guidelines used in the care of patients with TBI based on evidence showing that the body heals better when it is given proper nutrition, not just the bare minimum that keeps someone alive.

"Before now, patients were required to have nutritional supplementation within the first week following their injury, but our findings suggest that this is simply not soon enough," said lead author Roger Härtl, MD, NewYork-Presbyterian/Weill Cornell and Weill Cornell Medical College, New York, New York.

"The past recommendations were based only on common clinical observations and a very small study of only about 60 patients," said Dr. Härtl. "These new recommendations will be added to a widely used TBI handbook, Guidelines for Management of Severe Traumatic Brain Injury" published by the Brain Trauma Foundation.

Researchers followed survival outcome and nutritional care in 797 patients from 2000 to 2006 and recorded the length of time it took for each patient to receive gastric nutrition and how many calories they ingested.

After controlling for factors such as age, high blood pressure, brain pressure, prior neurological and cardiac conditions, and CT scan results shortly after the time of injury, the researchers found that the earlier each patient received a feeding-tube, and the more calories they ingested, the better their likelihood for survival.

Without gastric feeding within the first 5 to 7 days of suffering their injury, patients had a 2- to 4-fold higher likelihood of death. In addition, every 10 kcal/kg decrease in caloric intake was associated with a 30% to 40% increase in mortality rate.

The best outcomes for patients with TBI were observed when patients received a minimum of 25 kcal/kg each day. Alarmingly, the researchers found that as many as 62% of the patients studied never met this level of caloric intake.

"I think these findings say a lot about using what we know from basic research and applying the knowledge directly to the care we give to patients," Dr. Härtl said. "For a long time, clinicians thought that intravenous fluids were enough -- based on anecdotal situations and some basic biochemical knowledge -- but now we know that this level of care is not meeting the actual requirement the body needs to repair itself following extreme trauma."

SOURCE: NewYork-Presbyterian Hospital/Weill Cornell Medical Center

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