Principles of Enteral Feeding and Nutrition

Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting and affects morbidity and mortality in the neurotrauma population. The Australian Nutrition Care Day Survey reports rates of approximately 40% prevalence. Hospitalization with the diagnosis of malnutrition has been associated with longer lengths of stay, higher healthcare costs, immune system depression, impaired wound healing, muscle wasting, and up to 5 times the risk of mortality compared to other reasons for adult hospitalization. Early nutritional intervention may reduce complication rates, morbidity, mortality, and resource utilization 1, 2. The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (ASPEN) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice) 3, 4. There needs to be intentional management focused on the neurotrauma population with regard to nutrition and studies to develop more accurate protocols specific to each population during the neurocritical care period. Timing, dosing, type, and method of feeding and nutrition require these considerations and input given limited research; however, there are some basic standards that are a good start. Nutritional support typically should be started within 24–48 h post-injury for the neurotrauma population. The consulting physiatrist should understand and guide the management of different feeding tube types, placement locations, associated complications, and the timing of removal.