Energy balance and metabolism after severe traumatic brain injury: A pilot study using doubly labelled water
(English)Manuscript (preprint) (Other academic)
Objective: To explore the course of energy balance in patients with severe traumatic brain injury, from time of injury until twelve weeks post injury.
Method: This prospective desriptive study included six patients with isolated, closed severe traumatic brain injury and an expected hospital stay of ≥2-3 months. Energy balance was calculated from energy intake compared to total energy expenditure measured by continuous indirect calorimetry and doubly labelled water. Clinical and laboratory variables with possible influence on metabolism and nutritional delivery were recorded simultaneously. Intermittent indirect calorimetry measurements were used to differentiate components of the energy expended.
Results: Patients were roughly in energy balance while on mechanical ventilation, but in negative energy balance from the 3rd week post injury. The total energy expenditure then increased while the daily energy intake declined. Concurrent with this period were difficulties in retaining enteral and/or parenteral nutrition delivery routes until oral feeding was satisfactory. Nitrogen balance was back to normal at about 1.5 months and the inflammatory period with increased C-reactive protein levels continued for 12 to 58 days from time of injury. During the first and second month post injury, patients lost 8-19% of their initial body weight.
Conclusion: Data suggests that negative energy balance after a severe TBI could not only be explained by the elevated metabolic rate and catabolism induced by the trauma, but also by difficulties in securing alternative nutritional routes in the distressed patient.
Enegy balance, Metabolism, Traumatic brain injury, Doubly labelled water, Indirect calorimetry, Energy intake
Nutrition and Dietetics Anesthesiology and Intensive Care Surgery Nursing
Research subject Nutrition; Caring Sciences in Medical Sciences; Rehabilitation Medicine
IdentifiersURN: urn:nbn:se:uu:diva-114122OAI: oai:DiVA.org:uu-114122DiVA: diva2:293084