Metabolism and nutrition in patients with moderate and severe traumatic brain injury: A systematic review.

PRIMARY OBJECTIVE

To examine the evidence on the metabolic state and nutritional treatment of patients with moderate-to-severe traumatic brain injury (TBI).

RESEARCH DESIGN

A systematic review of the literature.

METHODS AND PROCEDURES

From 1547 citations, 232 articles were identified and retrieved for text screening. Thirty-six studies fulfilled the criteria and 30 were accepted for data extraction.

MAIN OUTCOMES AND RESULTS

Variations in measurement methods and definitions of metabolic abnormalities hampered comparison of studies. However, consistent data demonstrated increased metabolic rate (96-160% of the predicted values), of hypercatabolism (-3 to -16 g N per day) and of upper gastrointestinal intolerance in the majority of the patients during the first 2 weeks after injury. Data also indicated a tendency towards less morbidity and mortality in early fed patients.

CONCLUSIONS

The impact of timing, content and ways of administration of nutritional support on neurological outcome after TBI remains to be demonstrated.