Research Reports - Nutritional support for patients sustaining traumatic brain injury: a systematic review and meta-analysis of prospective studies
PLoS One. 2013;8(3)
Wang X, Dong Y, Han X, Qi XQ, Huang CG, Hou LJ
BACKGROUND: In traumatic brain injury (TBI), the appropriate timing and route of
feeding, and the efficacy of immune-enhancing formulae have not been well
established. We performed this meta-analysis aiming to compare the effects of
different nutritional support modalities on clinical outcomes of TBI patients.
METHODS: We systematically searched Pubmed, Embase, and the Cochrane Library
until October, 2012. All randomized controlled trials (RCTs) and non-randomized
prospective studies (NPSs) that compared the effects of different routes,
timings, or formulae of feeding on outcomes in TBI patients were selected. The
primary outcomes included mortality and poor outcome. The secondary outcomes
included the length of hospital stay, the length of ventilation days, and the
rate of infectious or feeding-related complications.
FINDINGS: 13 RCTs and 3 NPSs were included. The pooled data demonstrated that,
compared with delayed feeding, early feeding was associated with a significant
reduction in the rate of mortality (relative risk [RR] = 0.35; 95% CI,
0.24-0.50), poor outcome (RR = 0.70; 95% CI, 0.54-0.91), and infectious
complications (RR = 0.77; 95% CI, 0.59-0.99). Compared with enteral nutrition,
parenteral nutrition showed a slight trend of reduction in the rate of mortality
(RR = 0.61; 95% CI, 0.34-1.09), poor outcome (RR = 0.73; 95% CI, 0.51-1.04), and
infectious complications (RR = 0.89; 95% CI, 0.66-1.22), whereas without
statistical significances. The immune-enhancing formula was associated with a
significant reduction in infection rate compared with the standard formula
(RR = 0.54; 95% CI, 0.35-0.82). Small-bowel feeding was found to be with a
decreasing rate of pneumonia compared with nasogastric feeding (RR = 0.41; 95%
CONCLUSION: After TBI, early initiation of nutrition is recommended. It appears
that parenteral nutrition is superior to enteral nutrition in improving outcomes.
Our results lend support to the use of small-bowel feeding and immune-enhancing
formulae in reducing infectious complications.