Nutrition therapy in critically ill patients with traumatic brain injury

Road traffic collisions are the commonest cause of traumatic brain injury (TBI). Patients with brain injury may present with a wide range of symptoms depending on nature and types of injury. Generally, severity of TBI can be classified into mild, moderate and severe based on Glasgow Coma Scale (GCS). This scoring system objectively describes the extent of impaired consciousness. Score of 8 or below indicates severe TBI and will require admission to intensive care and mechanical ventilation. These patients experience significant metabolic changes as a result of excessive production of endogenous catabolic hormones following the injury. Nutritional requirements among these patients differ based on severity of trauma and phase of illness. Timely initiation of feed and addressing individualised nutritional needs can prevent malnutrition. Apart from that, nutrition plays a very important role in neuronal recovery and directly affects neuronal plasticity thus the prognosis. Early involvement of nutritional support as a part of comprehensive care is the key to recovery and better outcome. The aim of this review is to provide an overview of the current evidence-based nutrition therapy for patients with TBI in critical care settings. The review covers the energy and nutrient requirements, enteral and parenteral nutrition, and challenges associated with it.