Nutrition as a Predictor of Outcome in Patients with Severe Traumatic Brain Injury

Abstract
Background: Traumatic Brain Injury (TBI) is a critical socio-economic problem throughout the world. Immediately after TBI, there is an increase in catabolic and counter-regulatory hormones, leading to a hypermetabolic state which causes specific nutritional needs and multiple metabolic and electrolytic abnormalities. Nutritional intervention is likely to limit the patient's inflammatory response and thereby improve the ultimate health outcome.
Aim of Study: This study aimed to assess the effect of early nutrition on the rate of mortality in patients with severe traumatic brain injury.
Methods: The current work is a prospective randomized study that was conducted on 60 patients with severe traumatic brain injury. Patients were randomly classified into three groups (each was of 20 patients). Group I received enteral nutrition after 48 hours of TBI. Group II received early enteral nutrition within 1st 24 hours after TBI. Group III received early parenteral nutrition within 1st 24 hours after TBI.
Results: The three groups showed no statistically signif-icant differences as regard age, sex, mode of trauma, and presence of co-morbidities. As regard vital signs, laboratory investigations, finding of Computed Tomography (CT) of brain and surgical intervention, there was no statistically significant difference between both groups at baseline. There was significant improvement in GCS in groups II and III compared to group I despite there was no significant difference between the three groups at admission. As regard duration of mechanical ventilation, there was significant decrease in the duration of mechanical ventilation in group II compared to groups I and III. There was significant increase in infection in groups I (70%) and III (60%) compared to Group I (20%). There was significant difference in mortality rate between the three studied groups and between Group I and II. At 30 days of the study, 65% of patients in Group I died. While in Group II and III the percentage decreased to 20% and 45% respec-tively.
Conclusion: Administration of early enteral nutrition in this study has been associated with decreased mortality, decreased duration of mechanical ventilation, less incidence of infection and improved GCS patients with severe TBI.