Enteral versus parenteral nutrition after severe closed head injury.

We measured energy expenditure (MREE) and nitrogen excretion (UUN) in patients with severe head injury randomized to early parenteral (TPN, n=21) or jejunal (ENT, n=27) feeding with identical formulations. The MREE rose to 2400±531 kcal/day in both groups and remained at 135%±26% to 146%±42% of predicted energy expenditure over 4 weeks. Nitrogen excretion peaked the second week at 33.4±10 (TPN) and 31.2±7.5 (ENT) g N/day. Both routes were equally effective at meeting nutritional goals (1.2×MREE, 2.5 g protein/kg/day intake, stabilized albumin and transferrin levels). Infections were equally frequent: 1.86 episodes/TPN patient versus 1.89 episodes/ENT patient