Agressive Nutritinal Support after Severe Head Injury

Abstract

Severe head injuries as surgical insults, burn and sepsis, have been reported to induce hypermetabolic and hypercatabolic states with the accompanying hormonal changes. However, nutritional management has tended to be rather underestimated, while the potential risk of hyperalimentation against critical intracranial pressure(ICP)has been stressed. In this study, 2 weeks of aggressive nutritional support was adopted for 24 patients with severe head injuries(GCS&InE;8)under ICP monitoring, and its influence on ICP or its effects on various nutritional and immunological parameters were assessed. Eight cases dropped out from this study ; 5 cases fell into brain death within 4 days due to intracranial hypertension, and severe hyperglycemia could not be controlled in an other 3 cases. In 5 cases, out of the remaining 16 cases, who tolerated our hyperalimentation regimen well(more than 18g nitrogen/day, 2, 900〜3, 750Cal./day), the proper nitrogen balance, serum protein level and muscle volume could be kept. In contrast, in the 11 cases who received less than 18g nitrogen/day showed a negative nitrogen balance and muscle volume loss. No adverse effect on ICP was detected from the hyperalimentation, unless intractable electrlytes disorder or hyperglycemia occured. Septic pulmonary complications were seen in 2 cases, to whom enteral administration was started within 7 days. Aggressive nutritional management in cases with severe head injuries from an early stage can be carried out safely under strict electrolyte and blood suger control. The favorable effect of hyperalimentation therapy on metabolic status was shown in this study.