Early feeds not force feeds: enteral nutrition in traumatic brain injury

Exact same question for stroke. We'll never know because we have NO stroke leadership or strategy to answer such fuckingly simple questions.
http://journals.lww.com/jtrauma/Abstract/publishahead/Early_feeds_not_force_feeds___enteral_nutrition_in.99541.aspx
Azim, Asad MD; Haider, Ansab A. MD; Rhee, Peter MD, MPH; Verma, Ket MD; Windell, Elizabeth MD; Orouji Jokar, Tahereh MD; Kulvatunyou, Narong MD; Meer, Mary RD, CNSC; Latifi, Rifat MD; Joseph, Bellal MD

Published Ahead-of-Print

Abstract

BACKGROUND: Brain Trauma Foundation guidelines recommend the early use of enteral nutrition to optimize recovery following traumatic brain injury (TBI). Our aim was to examine the effect of early feeds (<=24 hours) on clinical outcomes after TBI.

MATERIALS: We performed a 3-year retrospective study of patients with severe TBI (GCS<8) who were intubated, admitted to the ICU, and received tube feeds. Early tube feeds (Early-TF) was defined as initiation of tube feeds within 24 hours, while Late tube feeds (Late-TF) was defined as initiation of tube feeds after 24 hours. Outcome measures included pneumonia rates, days on ventilator, hospital and ICU stay, and mortality rates.

RESULTS: A total of 90 patients (Early-TF: 58, Late-TF: 32) were included of which 73.3% were male, mean age was 42+/-20 years, and median h-AIS was 4 [3-5]. There was no difference in age (p=0.1), h-AIS (p=0.5), or admission GCS (p=0.9) between the 2 groups. Patients with Early-TF were associated with higher no of ICU days (p=0.03) and higher pneumonia rates (p=0.04) but there was no significant difference in mortality (p=0.44) as compared to those who underwent Late-TF.

CONCLUSION: Although early tube feeds are known to improve outcomes in TBI patients, our data suggests that early feeds in TBI patients are associated with higher rates of pneumonia and greater hospital resource utilization.