By Audrey Amara
| July 2nd 2008 06:47 AM | Print
Starve a fever, feed a traumatic brain injury. Recent studies by clinician-scientists from New York-Presbyterian Hospital and Weill Cornell Medical Center found that patients with traumatic brain injury, or TBI, have a higher survival rate when their caloric intake is increased.
Patients of TBI are fed through a gastric feeding tube inserted through a hole in the stomach for long-term eternal nutrition. The sooner the supplemental nutrition plan is initiated the better chance a patient has for survival, up to four times, researchers say.
Based on recent studies as published in the Journal of Neurosurgery, humans need energy to recover, especially from trauma. “The evidence shows that the body heals better when it is given proper nutrition, not just the bare minimum that keeps someone alive," said Dr. Roger Hrtl, a neurological surgeon at the medical center as well as assistant professor of neurological surgery at Weill Cornell Medical College.
Presently, patients are only required to have nutritional supplementation within the first week post-injury. However, Dr. Hrtl suggests, “this is simply not soon enough,” going on to reveal that previous studies are sparse. "The past recommendations were based only on common clinical observations and a very small study of only about 60 patients."
Recent studies used 797 TBI patients from 2000-2006. Factors such as age, high blood pressure, prior neurological and cardiac conditions, and Computed Tomography scan results shortly after the time of injury were all taken into consideration, in data documenting caloric intake and length of time receiving gastric nutrition.
Patients receiving 25kcal/kg each day had the highest recovery rate, though up to 62 percent of the brain trauma victims never received this. Similarly, for every 10kcal/kg decrease in calories there was a 30 percent higher mortality rate, proving that it is crucial for a TBI patient to utilize the gastric feeding tube at the earliest possible moment within the first week of the traumatic event, researchers found.
By publishing the results of the studies in “Guidelines for Management of Severe Traumatic Brain Injury,” a widely used TBI handbook by the Brain Trauma Foundation, Dr. Hrtl remains optimistic that application of findings like these will benefit future patients. "For a long time, clinicians thought that intravenous fluids were enough -- based on anecdotal situations and some basic biochemical knowledge -- but now we know that this level of care is not meeting the actual requirement the body needs to repair itself following extreme trauma."