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Nutrition and Traumatic Brain Injury Improving Acute and Subacute Health Outcomes in Military Personnel (2011) / Chapter Skim
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6 Energy and Protein Needs During Early Feeding Following Traumatic Brain Injury
Pages 79-87

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From page 79...
... , and using an intent-to-treat analysis, total parenteral nutrition (TPN) was found superior to enteral nutrition in reducing mortality, although it significantly increased the risk of infection (Doig et al., 2008)
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From page 80...
... , with the goal of maintaining lean tissue. Traditionally, total daily energy expenditure has been considered to be composed of basal energy expenditure, often estimated by the Harris-Benedict equations; activity energy expenditure, which is generally quite limited in hospitalized, critically ill patients; and a small component due to the thermal effect of feeding, representing about 10 percent of the total.
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From page 81...
... . Most critically ill patients receive their invasive nutritional support by enteral nutrition rather than through TPN for a variety of reasons, including concerns about the relative safety and ease of administration of the two modes of feeding.
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From page 82...
... . In this later study, patients received only enteral nutrition, had much lower energy and protein intakes, and hypoglycemia was substantially more common in the intensive insulin therapy group than in the first study (Van den Berghe et al., 2001, 2006)
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From page 83...
... Subsequent trials had tighter glucose control in the control group than in the original Van den Berghe study, where the control group received insulin only when blood glucose exceeded 200 mg/dL. Recent trials have thus been comparing very tight control accompanied by a high risk of hypoglycemia, to less severe control (to about the 150 mg/dL level)
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From page 84...
... Critical care guidance for TBI recommends increasing the amount of calories provided beyond actual energy expenditure. The committee concluded that, although increasing the amount of calories beyond expenditure might better improve lean tissue preservation, this feeding regimen increases the risk for hyperglycemia or gastrointestinal intolerance, depending on the feeding regimen employed (parenteral nutrition or enteral nutrition, respectively)
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From page 85...
... 2011. Permissive underfeeding and intensive insulin therapy in critically ill patients: A randomized controlled trial.
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From page 86...
... 2009. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: A meta-analysis of randomised controlled trials.
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From page 87...
... 2009. Clinical review: Intensive insulin therapy in critically ill patients: Nice-sugar or leuven blood glucose target?
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Key Terms

  • critically ill
  • intensive insulin
  • energy expenditure
  • van den
  • enteral nutrition

  • den berghe
  • critical care
  • traumatic brain
  • care medicine
  • brain injury

  • blood glucose
  • parenteral nutrition
  • intensive care
  • total energy
  • glucose control

  • enteral feeding
  • ill patients
  • total parenteral
  • intense insulin
  • glucose homeostasis

  • severe traumatic
  • systemic inflammatory
  • lean tissue
  • inflammatory response
  • permissive underfeeding

  • basal energy
  • tight glucose
  • enhanced enteral
  • energy intake
  • care unit


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