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Resources and routines for nutritional assessment of patients with severe traumatic brain injury
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
Department of Pediatric Anesthesia and Intensive Care, Karolinska University Hospital, Stockholm.
Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, 3-13 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the resources and routines for nutritional management until 6 months after severe traumatic brain injury. Methods: Data collection was performed by use of questionnaires to staff professionals at three regional neurosurgical intensive and 75 other care units and a retrospective survey of medical and nursing records from 64 patients treated at these units. Results: Resources in terms of qualified staff members were reportedly good, while nutritional guidelines were adopted in less than half of the units. Screening for malnutrition at admission was rarely performed and the nutritional data in medical and nursing records were incomplete, i.e. there was a lack of body weight measurements in more than one-third of the care unit episodes and of body height data in more than half of the patients and a declining surveillance of energy intake when patients changed from parenteral or enteral nutrition to oral intake. Assessment of energy requirements relied on calculations and the assignment of who was to estimate it varied depending on which nutritional route was used and also between unit specialities. Finally, information on energy requirement, weight development and body mass index was present in only 16%, 7% and in 2% of the transferrals. Conclusions: Despite good resources of qualified staff, the nutritional assessment routines were deficient, resulting in incomplete nutritional data and lost nutritional information.

Place, publisher, year, edition, pages
2010. Vol. 24, no 1, 3-13 p.
Keyword [en]
Nutrition, Head injury, Nutritional assessment, Critical care, Questionnaires, Quantitative approaches
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
URN: urn:nbn:se:uu:diva-114115DOI: 10.1111/j.1471-6712.2008.00677.xISI: 000274389900002PubMedID: 19497027OAI: oai:DiVA.org:uu-114115DiVA: diva2:293082
Available from: 2010-02-10 Created: 2010-02-10 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Energy Balance out of Balance after Severe Traumatic Brain Injury
Open this publication in new window or tab >>Energy Balance out of Balance after Severe Traumatic Brain Injury
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the research presented here was to expand the knowledge on metabolic course and nutritional outcome in patients with severe traumatic brain injury and to analyze the use and accuracy of different methods of assessment.

Study I, a systematic review of 30 articles demonstrated consistent data on increased metabolic rate, of catabolism and of upper gastrointestinal intolerance in the majority of the patients during early post injury period. Data also indicated a tendency of less morbidity and mortality in early fed patients.

Study II, a retrospective survey, based on medical records of 64 patients from three regions in Sweden, showed that the majority of patients regained their independence in eating within six months post injury. However, energy intake was set at a low level and 68 % of the patients developed malnutrition with 10 to 29 % loss of initial body mass during the first and second month post injury.

Study III, a questionnaire based study addressed to 74 care units caring for patients with severe traumatic brain injury showed that resources in terms of qualified staff members were reportedly good, but nutritional guidelines were adopted in less than half of the units, screening for malnutrition at admission was rarely performed and surveillance of energy intake declined when oral intake began. Moreover, assessment of energy requirements relied on calculations and the profession in charge to estimate energy requirement varied depending on nutritional route and unit speciality. At transferral between units nutritional information was lost.

Study IV and V, a prospective descriptive study on metabolic course, energy balance and methods of assessment in six patients showed that patients were in negative energy balance from 3rd week post injury and lost 8-19 % of their initial body weight. Concurrent nutritional problems were difficulties in retaining enteral and/or parenteral nutrition delivery routes until oral feeding was considered satisfactory. The majority of methods for predicting energy expenditure agreed poorly with measured energy expenditure.  The Penn-State equation from 1998 was the only valid predictive method during mechanical ventilation.

This thesis concludes that patients with moderate or severe traumatic brain injury exhibit a wide range of increased metabolic rate, catabolism and upper gastrointestinal intolerance during the early post-injury period. Most patients regain independence in eating, but develop malnutrition. Suggested explanations, other than the systemic disturbances early post injury, could be the use of inaccurate predictions of energy expenditure, deficient nutritional routines and difficulties in securing alternative nutritional routes until oral feeding is satisfactory. The impact of timing, content and ways of administration of nutritional support on neurological outcome after a severe traumatic brain injury remains to be demonstrated.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 74 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 523
Keyword
Energy expenditure, Traumatic brain injury, Metabolism, Nutrition
National Category
Nutrition and Dietetics Surgery Anesthesiology and Intensive Care Nursing
Research subject
Nutrition; Neurosurgery; Rehabilitation Medicine; Anaesthesiology and Intensive Care; Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-114130 (URN)978-91-554-7721-9 (ISBN)
Public defence
2010-03-25, Robergsalen, A40, Akademiska sjukhuset, ingång 40, 5 tr., Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-03-04 Created: 2010-02-10 Last updated: 2010-03-04Bibliographically approved

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