Key considerations for nutritional management in traumatic brain injury: A narrative review

Abstract

Patients with traumatic brain injury experience complications and sequelae that lead to dysfunction and an uncertain prognosis. Brain injury induces a state of hypermetabolism and hypercatabolism, increasing the energy requirements of patients and predisposing them to malnutrition if appropriate nutritional support is not initiated early. To investigate this issue, we conducted a narrative review through December 2022. Poor nutrition in neurosurgical patients elevates mortality rates and significantly amplifies the risk of post-surgical complications. Recent studies have revealed that patients with traumatic brain injury experience an increase in metabolism of up to 250%, resulting in significant nitrogen loss. These patients should consume no less than 15% of total calories in the form of protein, with amino acid intake approaching 2 g/kg based on the patient's ideal weight being beneficial. Studies have compared the effectiveness of parenteral and enteral nutrition in these patients, with enteral nutrition providing superior benefits. Enteral nutrition is consistent with human physiology and supports a healthy gastrointestinal tract, modulates the immune system, and reduces the risk of liver cholestasis, which is higher in parenteral nutrition.