Nutrition and Traumatic Brain Injury Improving Acute and Subacute Health Outcomes in Military Personnel (2011) / Chapter Skim
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2 Nutrition in Clinical Practice Guidelines for Traumatic Brain Injury
2 Nutrition in Clinical Practice Guidelines for Traumatic Brain Injury
Pages 23-30
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From page 23... ...
the clinician uses judgment when weighing the trade-offs associated with alternative management strategies, including consideration of patient values and preferences as well as societal values. As will be obvious in Chapters 6–16, much of the available evidence suggesting potential benefits of specific nutritional interventions in traumatic brain injury (TBI)
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From page 24... ...
More than 40 clinical guidelines for TBI were identified at the National Guideline Clearinghouse online database.1 However, many of these guidelines focus on emergency department treatment or evaluating for the presence or absence of TBI in primary care or sports settings, and only a few address nutritional concerns. In addition to guidelines developed specifically for TBI, generic evidence-based clinical practice guidelines for critical care of adults in intensive care units may also be appropriate in acute TBI.
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From page 25... ...
In contrast, other guidelines do recognize the importance of nutrition to accelerate progress in trauma patients. For example, the SCCM/ASPEN Guidelines for Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient include recommendations for timing of initiation of enteral nutrition, use of parenteral nutrition, dosage of enteral feeding, monitoring, intolerance and adequacy of enteral nutrition, selection of appropriate enteral formulation, adjunctive therapies, and maximizing the efficacy of parenteral nutrition, as well as specific recommendations for the following medical conditions: pulmonary failure, renal failure, hepatic failure, acute pancreatitis, and end-of-life treatments (McClave et al., 2009)
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From page 26... ...
However, it should be noted that these are recommendations for estimating the resting metabolic rate, and although they present a good starting point for determining total energy needs, they are not specific for TBI patients and do not account for injury factors. Meeting Energy Needs Enteral Nutrition The ASPEN and ADA EBGs recommend enteral feeding be started early, within the first 24–48 hours of admission, and advanced toward optimal nutrition goals over the next 48–72 hours (ADA, 2006; McClave et al., 2009)
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From page 27... ...
d A formula was considered accurate if it predicted resting metabolic rate within +/– 10% of measured resting metabolic rate. e The 2003a Penn State equation has been updated since these 2006 ADA guidelines.
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From page 28... ...
The VA/DoD Evidence-Based Clinical Practice Guideline for Management of Concussion/ Mild Traumatic Brain Injury (2009) includes a consensus document with definitions, classification and taxonomy, and guidelines and tools for initial presentation including screening and management of symptoms and follow-up of persistent symptoms for individuals with mild TBI.
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From page 29... ...
The body of research to support clinical practice guidelines specific to the nutrition care of TBI patients is extremely limited. To aid those preparing such guidelines, specific questions of interest for future research are included in Appendix C, Table B-3.
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From page 30... ...
2009. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM)
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