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Following Traumatic Brain Injury, Balanced Nutrition Saves Lives
July 02, 2008Clinician-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 30-40 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."
Co-authors of the study include Drs. Jam Ghajar, Linda Gerber and Quanhong Ni - all of NewYork-Presbyterian/Weill Cornell and Weill Cornell Medical College.
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
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 30-40 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."
Co-authors of the study include Drs. Jam Ghajar, Linda Gerber and Quanhong Ni - all of NewYork-Presbyterian/Weill Cornell and Weill Cornell Medical College.
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
Traumatic Brain Injury Current Events and Traumatic Brain Injury News RSSSpecial issue of NeuroRehabilitation focuses on hypoxic-ischemic brain injuries
IOS Press announces publication of a special issue of NeuroRehabilitation: An International Journal (NRE) devoted specifically to hypoxic-ischemic brain injury (HI-BI), a significant disruption of brain function due to a deficient supply of oxygen to the brain.
Helmets must be part of skiing and snowboarding culture, doctors urge
While the world's best skiers and snowboarders at the Vancouver 2010 Olympic Winter Games compete with helmets on, many other skiers and snowboarders are choosing to forego this important piece of safety equipment.
UC Study Supports Alternative Anti-Seizure Medication Following Acute Brain Injury
A study by researchers at the University of Cincinnati Neuroscience Institute (UCNI) at University Hospital supports the use of an alternative medication to prevent seizures in patients who have suffered a life-threatening traumatic brain injury or bleeding stroke.
Simple test may help judge concussion in athletes
A simple test of reaction time may help determine whether athletes have sustained a concussion (also known as mild traumatic brain injury) and when they are ready to play again.
Traumatic brain injuries: Motor deficits can persist even after what appears to be a full recovery
Even after regaining normal walking speed, traumatic brain injury (TBI) victims have not necessarily recovered all their locomotor functions, according to a study supervised by Université Laval's Bradford McFadyen and recently published in Archives of Physical Medicine and Rehabilitation.
Concussions not taken seriously enough: McMaster researcher
Despite growing public interest in concussions because of serious hockey injuries or skiing deaths, a researcher from McMaster University has found that we may not be taking the common head injury seriously enough.
Cell phone exposure may protect against and reverse Alzheimer's disease
The millions of people who spend hours every day on a cell phone may have a new excuse for yakking. A surprising new study in mice provides the first evidence that long-term exposure to electromagnetic waves associated with cell phone use may actually protect against, and even reverse, Alzheimer's disease.
NHLBI stops enrollment in study on resuscitation methods for cardiac arrest
Enrollment has ended early in a large, multicenter clinical trial comparing two distinct resuscitation strategies delivered by emergency medical service (EMS) providers to increase blood flow during cardiac arrest.
Master regulator found for regenerating nerve fibers in live animals
Researchers at Children's Hospital Boston report that an enzyme known as Mst3b, previously identified in their lab, is essential for regenerating damaged axons (nerve fibers) in a live animal model, in both the peripheral and central nervous systems.
First former college football player diagnosed with CTE
The Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University School of Medicine (BUSM) announced today that a deceased former college football player who died at age 42 was already suffering from the degenerative brain disease, Chronic Traumatic Encephalopathy (CTE).
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