Enhanced enteral nutrition in head injury: effect on the efficacy of nutritional delivery, nitrogen balance, gastric residuals and risk of pneumonia

Background: Early enhanced enteral nutrition (EN) improves clinical outcome in severe head injury. However, poor gastric emptying and certain aspects of intensive care may inhibit delivery of optimum nutrition. Aim: To determine the important causes of interruption to EN and whether attempting early adequate EN could enhance nutritional intake in severe head injury. Methods: Eighty-two patients were randomized to receive either standard EN or early adequate EN. Data was collected on nutritional intake, causes of interruption to EN, nitrogen balance, volume of gastric residuals and incidence of pneumonia. Results: The median percentage of energy and nitrogen delivered was greater in intervention patients compared to controls over the first week post-injury ( P < 0.02). During the first 96 h post-injury, patients received EN during 57% of the potential feeding time. Intervention patients received a higher fluid volume ( P < 0.02) but did not have a higher incidence of pneumonia. Conclusion: Taking into account the importance of initiating and maintaining adequate EN, prioritizing procedures in intensive therapy units could further improve nutritional intake in severe head injury.