Dietetic treatment with hypercaloric and hyperprotein intake in patients following severe brain injury.

ABSTRACT

Sixty four patients, following severe acute brain injury were fed according to a strict dietetic therapy at the Intensive Care Unit at the Institute of Neurological Surgery, University of Turin. We used mixtures composed of simple nutritional elements consisting of carbohydrate as glucose polymers from 7 to 15 units, free aminoacids and MCT oil, integrated with natural elements. The solutions were administered via a nasogastric tube with the maximum caloric intake of 6.000 Kcal and 186 grams proteins/24 hr. After recording a series of hematochemical and clinical parameters we obtained the following results: 1) the average blood sugar level was always found to be pathological among the 11 patients who eventually died during their hospitalization, while 30% of the discharged patients had normal blood sugar values; 2) kidney function was significantly more affected among eventually deceased patients than among discharged ones; 3) the hospitalization time had a negative influence on the hepatic functions. Total serum albumins and proteins cease their decline respectively at average values of 2 and 5.5% gr, cholesterol maintains a constant level between 180 and 200% gr, calcium between 8 and 9 mg% and phosphorous around 3 mg%. Alkaline phosphatase in all patients rose significantly to pathological values only after a week of hospitalization. All other tests presented an irregular course. The survival period of our group of patients was significantly longer than that of control group. Within our group the survival rate was better among patients who received, within 10 days from cerebral damages, a hypercaloric and hyperprotein diet of more than 5.000 Kcal and 120 grams of proteins in 24 h, as compared to those whom the same diet was administered more gradually or following a longer period of time after having sustained cerebral damage.