ARTIFICIAL NUTRITION OF THE HEAD-INJURED PATIENT

In head-injured patients the nutritional support is aimed to prevent d enutrition status usually observed. The adequate amount of calories de pends on the basal metabolism las calculated with the Harris Benedict equation). It has to be increased in case of fever (by a 0.1 factor pe r degree above 37 degrees C), sepsis (by a 0.1 to 0.2 factor) or when sedation is discontinued (by a 0.3 factor). The increased proteolysis is not modified by the associated treatment and results in an inevitab le protein loss, whatever the qualitative change in nutritional suppor t. In clinical practice, the nutritional support has to be adjusted co ntinuously to the needs of the patient, to avoid a more pronounced den utrition due to the summation of daily nutritional deficits. (C) 1998 Elsevier, Paris.