Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury.
OBJECTIVE
To determine the effect of early enhanced enteral nutrition (EN) on clinical outcome of head-injured patients.


METHODS
Prospective, randomized, controlled trial.


METHODS
Tertiary neurosurgical and trauma center.


METHODS
Eighty-two patients suffering head injury and requiring mechanical ventilation.


METHODS
Patients were randomized to receive standard EN (gradually increased from 15 mL/hr up to estimated energy and nitrogen requirements) or enhanced EN (started at a feeding rate that met estimated energy and nitrogen requirements) from day 1. Good neurologic outcome (Glasgow Outcome Scale score of 4 or 5) was determined at 3 and 6 months after injury, and the incidence of infective and total complications was determined during the hospital stay up to 6 months.


RESULTS
Disease severity assessed by best preintubation Glasgow Coma Scale score, pupillary responses, Injury Severity Score, Acute Physiology and Chronic Health Evaluation II score, computed tomographic scan categorization, and age was similar in both groups. Intervention patients had a higher percentage of energy (p = .0008) and nitrogen (p<.0001) requirements met by EN in the first week after injury. Neurologic outcome at 6 months was similar between groups, but there was a tendency for more intervention patients to have a good neurologic outcome at 3 months than control patients (61% vs. 39%, p = .08). Fewer intervention patients had an infective complication (61% vs. 85%, p = .02) or more than one total complication (37% vs. 61%, p = .046) compared with control patients. Enhanced EN was associated with a reduction in the ratio of serum concentration of C-reactive protein to albumin up to day 6 after injury (p = .004).


CONCLUSIONS
Enhanced EN appears to accelerate neurologic recovery and reduces both the incidence of major complications and postinjury inflammatory responses.
Taylor
S J
SJ
Department of Nutrition and Dietetics, Frenchay Hospital, Bristol, UK. 113623-063@compuserve.com
Fettes
S B
SB
Jewkes
C
C
Nelson
R J
RJ
D001930:Brain Injuries / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D004750:Enteral Nutrition; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D007902:Length of Stay; D011446:Prospective Studies; D012121:Respiration, Artificial; D012709:Serum Albumin / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome
D012709:Serum Albumin; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein