title: Nutrition support practices in critically ill head-injured patients: a global perspective.
abstract: BACKGROUND
  Critical illness following head injury is associated with a hypermetabolic state but there are insufficient epidemiological data describing acute nutrition delivery to this group of patients. Furthermore, there is little information describing relationships between nutrition and clinical outcomes in this population.
  
  
  METHODS
  We undertook an analysis of observational data, collected prospectively as part of International Nutrition Surveys 2007-2013, and extracted data obtained from critically ill patients with head trauma. Our objective was to describe global nutrition support practices in the first 12 days of hospital admission after head trauma, and to explore relationships between energy and protein intake and clinical outcomes. Data are presented as mean (SD), median (IQR), or percentages.
  
  
  RESULTS
  Data for 1045 patients from 341 ICUs were analyzed. The age of patients was 44.5 (19.7) years, 78% were male, and median ICU length of stay was 13.1 (IQR 7.9-21.6) days. Most patients (94%) were enterally fed but received only 58% of estimated energy and 53% of estimated protein requirements. Patients from an ICU with a feeding protocol had greater energy and protein intakes (p <0.001, 0.002 respectively) and were more likely to survive (OR 0.65; 95% CI 0.42-0.99; p = 0.043) than those without. Energy or protein intakes were not associated with mortality. However, a greater energy and protein deficit was associated with longer times until discharge alive from both ICU and hospital (all p <0.001).
  
  
  CONCLUSIONS
  Nutritional deficits are commonplace in critically ill head-injured patients and these deficits are associated with a delay to discharge alive.
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia. lee-anne.costello@adelaide.edu.au.
authors.forename: Lee-Anne S
authors.initials: LA
authors.lastname: Chapple
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia. Marianne.chapman@health.sa.gov.au.|Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia. Marianne.chapman@health.sa.gov.au.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Chapman
authors.affiliation: Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia. kylie.lange@adelaide.edu.au.
authors.forename: Kylie
authors.initials: K
authors.lastname: Lange
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia. adam.m.deane@gmail.com.|Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia. adam.m.deane@gmail.com.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Deane
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada. dkh2@queensu.ca.|Queen's University, Kingston, Ontario, Canada. dkh2@queensu.ca.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D006259:Craniocerebral Trauma / Q000150:complications* / Q000178:diet therapy* / Q000453:epidemiology; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000009:adverse effects / Q000379:methods*; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies