Research Reports - Energy and protein deficits throughout hospitalization in patients admitted with a traumatic brain injury

Clin Nutr. 2016 Feb 23. pii: S0261-5614(16)00066-2. doi:
10.1016/j.clnu.2016.02.009. [Epub ahead of print]

Chapple LS(1), Deane AM(2), Heyland DK(3), Lange K(4), Kranz AJ(5), Williams
LT(6), Chapman MJ(7).

BACKGROUND AND AIMS: Patients with traumatic brain injury (TBI) experience
considerable energy and protein deficits in the intensive care unit (ICU) and
these are associated with adverse outcomes. However, nutrition delivery after ICU
discharge during ward-based care, particularly from oral diet, has not been
measured. This study aimed to quantify energy and protein delivery and deficits
over the entire hospitalization for critically ill TBI patients.
METHODS: Consecutively admitted adult patients with a moderate-severe TBI
(Glasgow Coma Scale 3-12) over 12 months were eligible. Observational data on
energy and protein delivered from all routes were collected until hospital
discharge or day 90 and compared to dietician prescriptions. Oral intake was
quantified using weighed food records on three pre-specified days each week. Data
are mean (SD) unless indicated. Cumulative deficit is the mean absolute
difference between intake and estimated requirements.
RESULTS: Thirty-seven patients [45.3 (15.8) years; 87% male; median APACHE II 18
(IQR: 14-22)] were studied for 1512 days. Median duration of ICU and ward-based
stay was 13.4 (IQR: 6.4-17.9) and 19.9 (9.6-32.0) days, respectively. Over the
entire hospitalization patients had a cumulative deficit of 18,242 (16,642) kcal
and 1315 (1028) g protein. Energy and protein intakes were less in ICU than the
ward (1798 (800) vs 1980 (915) kcal/day, p = 0.015; 79 (47) vs 89 (41) g/day
protein, p = 0.001). Energy deficits were almost two-fold greater in patients
exclusively receiving nutrition orally than tube-fed (806 (616) vs 445
(567) kcal/day, p = 0.016) while protein deficits were similar (40 (5) vs 37
(6) g/day, p = 0.616). Primary reasons for interruptions to enteral and oral
nutrition were fasting for surgery/procedures and patient-related reasons,
respectively.
CONCLUSIONS: Patients admitted to ICU with a TBI have energy and protein deficits
that persist after ICU discharge, leading to considerable shortfalls over the
entire hospitalization. Patients ingesting nutrition orally are at particular
risk of energy deficit. 

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