The role of nutritional support in the intensive care management of severe traumatic brain injury

Abstract

Objective. To compare the effectiveness of different nutritional support programs in patients with severe traumatic brain injury (TBI) during comprehensive intensive care.
Materials and methods. The study, conducted from 2017 to 2024, included 116 patients with severe TBI admitted to the ICU. Patients were randomized into two groups with different nutritional support strategies. The methods included evaluating clinical and laboratory parameters, catabolism levels, and outcomes using the Glasgow Outcome Scale, alongside durations of mechanical ventilation, intensive care, and hospital stay, as well as complication frequency.
Results. Patients in the intervention group received target levels of energy (28.84—33.59 kcal/kg/day) and protein (1.08—1.73 g/kg/day) from the first day of hospitalization, whereas in the control group the values were significantly lower (0—30.62 kcal/kg/day; 0—1.27 g/kg/day) (p < 0.05). C-reactive protein levels did not differ significantly between the groups throughout the observation period, while procalcitonin concentrations were significantly lower in the intervention group on days 3, 5, and 7 (p < 0.05); at other time points, the differences were not statistically significant. The median duration of hospitalization was longer in the intervention group (47 vs. 26 days, p < 0.05), while the incidence of complications was lower (pneumonia: 57.6 % vs. 84.0 %, p < 0.05; multiple organ dysfunction syndrome: 16.7 % vs. 34.0 %, p < 0.05). Mortality in the intervention group was 51.5 % compared to 80.0 % in the control group (p = 0.0261), and favorable outcomes occurred more frequently (40.9 % vs. 14.0 %, p < 0.05).
Conclusion. A nutritional support program aimed at achieving ≥ 30 kcal/kg/day of energy and ≥ 1.5 g/kg/day of protein intake contributed to a reduction in mortality and complication rates and improved clinical outcomes. The longer hospital stay observed in the intervention group may reflect increased survival and the need for extended rehabilitation time.