Following traumatic brain injury, balanced nutrition saves lives

Clinician-scientists from NewYork-Presbyterian Hospital/Weill Cornell Medical Center are suggesting an immediate and important change to guidelines used in the care of patients with traumatic brain injury (TBI). The researchers say that following TBI, patients should be given nutritional supplementation through a gastric feeding tube as soon as possible, which they say can improve their chances of survival by as much as four-fold.

The evidence shows that the body heals better when it is given proper nutrition, not just the bare minimum that keeps someone alive," says lead author Dr. Roger Härtl, a noted neurological surgeon at NewYork-Presbyterian/Weill Cornell, and the Leonard and Fleur Harlan Clinical Scholar and assistant professor of neurological surgery at Weill Cornell Medical College. "Before now, patients were required to have nutritional supplementation within the first week following their injury, but our findings suggest that this is simply not soon enough."

The study's findings are published in this month's issue of the Journal of Neurosurgery.

This is the largest study to ever look at the issue of nutrition and survival following TBI. The research team followed survival outcome and nutritional care in 797 patients from 2000-2006.

"The past recommendations were based only on common clinical observations and a very small study of only about 60 patients," says Dr. Härtl. "These new recommendations will be added to a widely used TBI handbook, 'Guidelines for Management of Severe Traumatic Brain Injury,'" published by the Brain Trauma Foundation.

To formulate their findings, the research team recorded the length of time it took for each patient to receive gastric nutrition and how many calories they ingested. After controlling for factors like age, high blood pressure, brain pressure, prior neurological and cardiac conditions, and CT scan results shortly after the time of injury, the researchers found that the earlier each patient received a feeding-tube, and the more calories they ingested, the better their likelihood for survival.

Without gastric feeding within the first 5-7 days of suffering their injury, patients had a two- and four-fold higher likelihood of death, respectively. Also, the study reports that every 10kcal/kg decrease in caloric intake was associated with a 30�� percent increase in mortality rate.

The best outcomes for patients with TBI were observed when patients received a minimum of 25kcal/kg each day. Alarmingly, the researchers found that as many as 62 percent of the patients studied never met this level of caloric intake.

"I think these findings say a lot about using what we know from basic research and applying the knowledge directly to the care we give to patients," says Dr. Härtl. "For a long time, clinicians thought that intravenous fluids were enough -- based on anecdotal situations and some basic biochemical knowledge -- but now we know that this level of care is not meeting the actual requirement the body needs to repair itself following extreme trauma."

Source: New York- Presbyterian Hospital

Related stories:

Pill ingredient could prevent brain damage after head injury
A common component of the contraceptive pill (progesterone) could improve the neurologic outcome for patients with severe head injuries, according to a study published in BioMed Central’s open access journal Critical Care.
Virtual reality and computer technology improve stroke rehabilitation
Israeli hospitals have recently started to use virtual reality therapy for stroke patients. One commonly used program has the patient watch his virtual image on a screen. For example, tennis balls are virtually thrown at the patient from all directions and the patients' actual hand motions are recorded on screen.
Head injuries result in widespread brain tissue loss one year later
In a rare, large-scale study of traumatic brain injury (TBI) patients who span the full range of severity from mild to moderate and severe, Canadian researchers have found that the more severe the injury, the greater the loss of brain tissue, particularly white matter.
Imaging shows structural changes in mild traumatic brain injury
Researchers report that diffusion tensor imaging can identify structural changes in the white matter of the brain that correlates to cognitive deficits even in patients with mild traumatic brain injury. The study is published in the October issue of the journal Brain.
How brain injury leads to seizures, memory problems
In a finding that may provide a scientific basis for eventual treatment, neurology researchers have shown that traumatic brain injury reduces the level of a protein that helps keep brain activity in balance. The resulting abnormal activity, in turn, is thought to be an underlying reason for seizures and memory defects experienced by people who have suffered a traumatic brain injury (TBI).
Scientists adapt economics theory to trace brain's information flow
Scientists have used a technique originally developed for economic study to become the first to overcome a significant challenge in brain research: determining the flow of information from one part of the brain to another.
Computer mouse driven by sound
Say "ahh" and the cursor zips toward the northeast corner of the computer screen. "Ooo" sends it shooting straight south. Want it to head southeast? Say "ohh." To make the cursor do a circle or figure 8, let vowel sounds bleed into one another, like eee into ahh into aww and so on. You can make it hurry or slow by regulating the volume of your voice. To open a link, make a soft clicking sound.
Protein shown to play a key role in normal development of nervous system
A protein that enables nerve cells to communicate with each other plays a key role in controlling the developing nervous system. Research into how that protein helps precise connections to form among nerve cells may provide a basis for eventual treatments for patients who suffer injuries to their nervous system, including spinal cord injury.

News discussion:

Medicine & Health news