EARLY ENTERAL FEEDING OF THE HEAD TRAUMA PATIENTS

Until some years ago, patients suffering from head injury were poorly fed and nutrition was not a primary concern in the medical treatment o f these patients. To date, six studies on head-injury patients have ex amined the effect of nutritional support on their outcome. All showed that lack of adequate nutrition contributed to increased mortality and morbidity. Head-injured patients on conventional enteral nutrition re ceive significantly less calories and proteins, resulting in an increa sed morbidity and mortality rate. Most of the severely head injured pa tients receiving enteral nutrition do not tolerate enteral feedings be cause of abnormal gastric emptying. The mechanisms of altered gastric function remain obscure. Increased intracranial pressure, cytokines, c orticotropin-releasing factor, opiates, and other agents may all play a role. Impaired gastric motility has led to increasing use of small b ower feeding in head-injured patients. Jejunal feeding enables a highe r caloric input and a better nitrogen balance. Moreover, it enables ea rly enteral administration of nutrients in a safe and efficient way. E arly administration of nutrients may be extremely important as it seem s to decrease the hypermetabolic response to traumatic injury. Therefo re, early jejunal enteral feeding may become an important cornerstone in the medical management of head-injured patients. (C) 1998 Elsevier, Paris.