Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries

Background: Although early enteral feeding clearly reduces septic morbidity after blunt and penetrating trauma, data for head-injured patients are con flicting. This study examines the effects of early us delayed enteral feedi ngs on outcome in patients with severe closed-head injuries with a Glasgow Coma Scale (GCS) score greater than 3 and less than 11. Methods: Thirty pat ients were prospectively randomized to receive an immune-enhancing diet (Im pact with fiber) early (initiated < 72 hours after trauma) delivered via an endoscopically placed nasoenteric tube (Stay-Put)or late (administered aft er gastric ileus resolved). This formula was continued for 14 days or until the patient tolerated oral feeding. Goal rate of nutrition was 21 nonprote in cal/kg/d and 0.3 g N/kg/d. Results: Two patients in the early group were excluded due to inability to place the tube, and one patient in the late g roup died before 72 hours. Five of the remaining 27 died, 1 in the early gr oup and 4 in the late group. There were no significant differences between the groups in length of stay, intensive care unit (ICU) days, significant i nfection, or GCS score. However, major infection correlated inversely with admission GCS score (R = -0.6, p <.003). Time to reach a GCS score of 14 wa s significantly longer in patients with significant infections compared wit h those without (p <.02). Conclusions: No difference in length of stay or i nfectious complications is shown in patients with severe closed-head injury when they are given early us delayed feeding using an immune-enhancing for mula. Severity of the head injury is closely associated with significant in fection.